Minority report

Published: 02/10/2003, Volume II3, No. 5875 Page 40 41

Trusts are failing to follow DoH and Commission for Racial Equality guidance to improve diversity in the workplace. Emma Forrest reports

Despite a tightening up of race relation laws, trusts are lagging behind in their implementation and staff still need convincing that colour will not be a bar to their career progression.

Racial Equality and NHS Trusts, a 2001 Commission for Racial Equality report, painted a woeful picture of racial equality schemes in the NHS.

It concluded that despite guidance from both the CRE and the Department of Health, 'the NHS has been slow to ensure racial equality for its workforce... very few employers had formal action plans or programmes to take their policies off the page'.

Published just months before the implementation of the Race Relations (Amendment) Act, it reported that of the few trusts that did have equality programmes in place, 34 per cent had not told staff about them.

The Department of Health's equality programme Positively Diverse (see box one) comes under the auspices of the Improving Working Lives standard, which backs the development of black and ethnic minority staff networks at all trusts.

The establishment of these networks is regarded as key to improving the lot of NHS ethnic minority workers. But they often follow earlier models formed by staff who felt they did not have a voice in formal channels.

'When people come to our events their faces light up as they now have someone working for them, ' says Hazel Alexander, heath and race programme manager at Central Middlesex Hospital and member of the North West London Hospitals trust black and ethnic minority network Aspire. After a series of informal meetings, a more formal structure was put in place in 2001 with central funding.

'There were too many people who came over [to the UK] and started working in the NHS in the 1960s who were still on the same grade when they retired in the 1990s. We want to raise morale among staff, raise their expectations and meet them. There are a lot of people who should simply be in higher positions, ' says Ms Alexander.

This is a common complaint. CRE figures show black and ethnic minority staff are overrepresented in lower grades.

Ms Alexander backs these up, saying most members of the north west London network are in nursing - including community-based posts - and midwifery. Senior managers who want to rise to deputy director status are also part of the network. They all have one thing in common; wanting promotion but feeling unable to seek it.

Not seeing people of an ethnic minority background in senior positions has a continuing negative effect. Raising selfesteem is seen as key to changing this, with the network providing training and mentoring services.

Breakthrough, an NHS Leadership Centre scheme due to launch this month, aims to increase the number of leaders coming from black and ethnic minority backgrounds.

It is unclear how much racism plays a part in the underachievement of ethnic minority staff. What is clear is that racism is perceived to be a problem by those who may be the target.

DoH research has found that racist bullying and harassment was far more common than was reported (see box two), perhaps unsurprisingly when ethnic minority staff also reported that they felt less able to discuss concerns about the organisation than white colleagues.

'Racism in the NHS is very subtle and very institutional, ' says Lynette Phillips, chair of the London Black and Minorities Network for NHS Staff and Allied Professionals.

Ms Phillips believes targets should be in place for recruiting and retaining black and ethnic minority staff, particularly in senior roles, to kick-start equality policies. But she acknowledges many within the NHS disagree with her.

Organisations are obliged to reflect the population they serve but targets have not generally been put in place.

There are suggestions on how to recruit more ethnic minorities through advertising.

Positively Diverse promotes the use of job shops that advertise all local NHS vacancies at all levels, displayed in languages spoken by the local population.

Managers point out that language is not the only barrier.

'There are lot of young white men working in hospitals who do well and get promoted, but you do not see young black men in equivalent numbers. Who are jobs promoted to and where are they advertised?' asks Ms Alexander.

Turnaround is possible. After DoH research found the ambulance services workforce included just 0.56 per cent ethnic minorities, the Ambulance Service Association began a scheme to actively recruit them.

It was the first time the issue had been addressed within the sector.

'There were about six services with no black and ethnic minority staff at all. Many were not aware that their profile did not fit the community they were serving. Ethnic background was not recorded when people joined the service at some groups, ' says former ASA programme leader John Batchelor.

Mr Batchelor says the benefits of employing ethnic minority staff had to be pointed out to both the public and the service.

Larger services were encouraged to employ diversity managers.

'It was about marketing the service to people as somewhere they would be welcome to work in, ' he says. He denies that the lack of diversity could be attributed to racism. 'It was laziness on the part of the leaders. They could not see the business sense in hiring Bengali or Pakistani staff in Tower Hamlets, where some white staff might not want to work because of the language difficulties.'

Rather than set targets for black and ethnic minority recruitment, year-on-year improvement is expected. 'If the local population has 20 per cent ethnic minorities, then the service should have that too, ' says Mr Batchelor. Numbers of black and ethnic minority staff in ambulance trusts has risen to 3.3 per cent, or 1,190 staff, and should now be actively sought by ambulance trusts.

Service delivery is also key.

There are concerns that patients are not properly served unless they see an ethnic mix working in NHS organisations and can be helped by someone who understands their cultural background and needs.

'It makes the patient more comfortable if they see someone who they know will understand their cultural background, ' says Mr Batchelor.

Though Positively Diverse leads have separate funding for the initiative, black and ethnic minority networks are run on a voluntary, sparsely funded basis.

This means they largely rely on the commitment of those who run them and the desire of staff to have a network in the first place.

'The fact that there are equality schemes in place is a plus, ' says Ms Alexander of the north west London network.

'But in the long term, we should not have to have a network. It should also change over time. At present it has a bias towards AfroCaribbean and Asian staff, but there are staff from all parts of the world. This should start to be reflected in the network. It would be very disappointing if Philippine nurses coming over now have the same problems as my mum did in the 1960s.'

Box 1: Positively Diverse

Positively Diverse is the Department of Health's lead scheme on improving recruitment and retention rates among ethnic minorities.

Staff audits undertaken by 37 Positively Diverse pilots, published in 2000 after a two-year trial period, found that although workforces seemed at first glance to reflect the ethnic diversity of the local population, this was not reflected across all grades of staff or professional groups.

Ethnic minority staff tended to have less belief than their white colleagues that their organisation made clear commitments to equal opportunities.

Almost a third of ethnic minority staff said they had experienced harassment and bullying due to their race, compared with 5 per cent of white staff. These figures were more than had been reported through formal systems.

As a result of the survey, the Positively Diverse programme was launched in 2001 and are now in place at 150 trusts. There are 10 sites leading the programme.

In the main, targets for the percentage of black and ethnic minority staff to be employed in an organisation have not been set, but the aim is to employ a reflection of the local population. The programme's aims include:

An increase in the number of people from ethnic minority groups entering professional training.

Improving retention rates, including lower turnover of minority ethnic staff and less early retirement due to disability.

Improving awareness of equal opportunities and diversity issues.

Organisations that are skilled in working cross culturally.

Box 2: some statistics

Commission for Racial Equality research carried out in 2000 found that black and ethnic minority staff were over-represented in midwifery, services for the elderly, nursing assistants and professions allied to medicine.

Department of Health figures from September show that around 1 per cent of executive nurses are from black and ethnic minority backgrounds.

Ethnic minorities make up 12.5 per cent of nurses, midwives and health visitors, 5.1 per cent of allied health professionals and 3.3 per cent of qualified ambulance staff. Nurse consultants are 5.7 per cent made up of ethnic minorities, nurse managers 6.6 per cent, healthcare assistants are 9.3 per cent and 8.8 per cent of non-medical staff.

Of hospital doctors, 28 per cent are from a black or ethnic minority background but only 16 per cent of consultant posts.

Box 3: the law

Under the Race Relations (Amendment) Act 2000, all public authorities have an explicit duty to eliminate racial discrimination, and promote equal opportunities and good race relations.

All organisations had until 31 May 2002 to put in place a race equality scheme to last at least three years. The schemes are supposed to assess whether policies are relevant to race equality, monitor their progress regarding race and consult on all new policies.

A code of practice from the Commission for Racial Equality suggests that data on staff ethnic background and how this applies to applicants for jobs, promotion and training should be published annually. Grievances, disciplinary action, performance appraisal training and dismissals should also be monitored.

Further information

Racial Equality and NHS Trusts.

www. cre. gov. uk

www. doh. gov. uk/nhsequality/ improvingworkinglives

www. doh. gov. uk/positivelydiverse