The NHS is the biggest employer of black and ethnic-minority staff, yet that is not reflected at management level. Lorraine Foster and Sarah James explain how one trust is trying to redress the balance

If you look at your organisation, where are most of your ethnic minority staff situated? How many black or ethnic minority employees are there in middle and senior management?

At King's Healthcare trust about a third of the workforce comes from ethnic minorities. But like many other NHS organisations we realised we needed to do more to help their career development. Three years of staff surveys showed that black and ethnic minority employees at King's College Hospital saw themselves as having significantly fewer opportunities than their white colleagues. They were situated at the lower end of management in all professional groups and in some groups no manager from a black or ethnic minority background could be identified. No wonder that some authors have suggested that black and ethnic minority personnel have remained an untapped resource within the NHS.

As the UK's largest employer of ethnic-minority staff, the NHS has to take action to redress the current imbalance. This is recognised in the Vital Connections initiative, which provides an equalities framework for the NHS.

3The framework is designed to ensure that there is 'a connection between achieving equality and inclusiveness in employment, education and training, and driving up service quality and improving health of all'. The challenge is how to translate this into practice.

At King's, staff from ethnic minorities account for half the ancillary workforce, and about 40 per cent of the nursing workforce, but occupy under a third of senior positions in all areas. Members of King's senior management felt action was needed to help people from ethnic minorities realise their potential.

They decided to set up a programme to enhance career advancement for this group. The first step was to identify a baseline (numbers of black and ethnicminority employees and at what grades, in which professions, length of employment, gender and age) before developing a strategy.

Before the launch of the Vital Connections initiative, King's College Hospital was already one of the 37 sites in the Positively Diverse national programme, which aims to optimise diversity and equal opportunities in the NHS.

A 'valuing diversity' group was formed by those who had identified themselves as having an interest in diversity. Its members were three board directors, a consultant dermatologist, the principal chief perfusionist, the employee relations manager, the occupational health service manager, a senior management accountant, the head of the change management programme, and the portering and security manager. This group developed two main objectives:

to change the culture of King's to ensure that all employees felt included as part of an organisation that values diversity;

to change the culture of King's to one in which value was placed on challenging intolerant attitudes and behaviour.

Key areas for action were:

training for managers;


embedding King's in the community;

positive action;

managing hostility.

A seminar was held to celebrate the achievements of the trust's black and ethnic minority employees.

All ethnic minority staff from supervisory, junior and senior management grades were invited.

We asked role models from ethnic-minority backgrounds for a short biography and photograph of themselves. We developed them into posters and placed them around the seminar room. Six of the role models attended the seminar, including Dame Jocelyn Barrow, a founding member of the Campaign Against Racial Discrimination, who told the audience: 'You must be prepared to cope with change, know what you want to get out of it and be an agent for change yourselves. '

Nola Ishmael, a nursing officer at the Department of Health, responsible for ethnic health and ethnic staff development, also spoke at the seminar. As did Sir Herman Ouseley, managing director of the Different Realities Partnership, and former chair of the Commission for Racial Equality.

Challenging stereotypes Instead of focusing on the 'gatekeepers'within the trust and how they use their power to recruit, promote, prevent discrimination and harassment, the programme set out to empower those members of staff who might previously have been 'invisible'.

Having established that only a handful of employees from ethnic minority backgrounds were represented at senior management level, the 'valuing diversity' group developed a range of strategies to build on the seminar: mentoring, action learning sets and self-marketing skills training.

Mentoring aims to make black and ethnic minority employees more 'visible' and develop processes which enable two-way learning to take place. Forty-two senior managers within the trust volunteered to act as mentors to ethnic minority employees. Training was provided for mentors and the mentored by an external consultancy with expertise in managing diversity in the workplace.

The mentors are now an accessible resource for ethnic minority employees.

Eleven staff are currently being mentored, with a further six about to start. Of the 11 well-established partnerships, three are from nursing, three from management and the rest from midwifery, support services and information technology.

Further support is being offered over the next nine months. Both mentors and mentored can meet with the external consultants again to explore the mentor-mentored relationship. This approach has challenged stereotypes and raised awareness while developing partnerships.

The learning sets aim to identify personal and professional development and training opportunities that will enhance participants' abilities to succeed at King's and within the NHS.

Two sets are up and running with eight participants.

The action learning sets are being developed with the external consultants who provided the expertise in the mentoring programme. The sets have been designed to ensure that the first cohort can become role models and mentors to other employees.

This training aims provide people with the necessary skills to project their best qualities in a variety of forums. Skills training has included curriculum vitae preparation, interview skills and self-reflection, with 32 staff attending selfmarketing training so far.

Organisational benefits This approach offers:

greater awareness of the contribution of black and ethnic minority staff;

a larger pool of staff identified for succession planning purposes;

explicit understanding of the key skills by which staff gain advancement;

greater awareness among senior managers and the trust of the possible barriers to the success of ethnic minority staff.

Central features have been lack of blame and willingness to get involved. Many healthcare providers have tried approaches in the past with limited benefits. In some organisations this has inevitably created apathy towards any initiative bearing an equal opportunities stamp. Despite this, much good work can be found throughout the NHS.

'I realised that I was not where I wanted to be on the success ladder, ' commented Marlene Johnson, a staff nurse who has worked at King's for more than 10 years, after last July's seminar. Coming from an ethnic minority background, Ms Johnson, like many of her counterparts, felt there were other dimensions specific to ethnicity that may have hindered her development. But she has since gained a sister's post.

Removing barriers to progression is a vital feature of managing diversity in the workplace, and at King's the first steps have been taken to enable this to happen.


1 Modood T et al. Ethnic Minorities in Britain: diversity and disadvantage. Policy Studies Institute, 1998.

2 Local Government Board. Evening the Odds: research into management development for black and other minority ethnic managers. LGB, 1997.

3 Department of Health. The Vital Connection: an equalities framework for the NHS. DoH, 2000.