The progress that NHS organisations have made in equality, diversity and human rights is something to be proud of but much more still needs to done, says Carol Baxter

human figures in a circle


We have come a long way since the early days of the NHS in the 1950s when the emerging black NHS workforce was largely a product of social engineering as the supply of affordable new staff from nearby Ireland had dried up.

Recruitment campaigns for nurses were extensively and energetically pursued with senior British nurses visiting Commonwealth countries personally for this purpose.

‘BME staff are overrepresented in “less attractive” specialisms and lower grades and have fewer opportunities for development’

Nowadays we have vigorous policies to encourage social justice and equal opportunities. The health service now welcomes good recruits from all backgrounds. Furthermore, it knows how important it is for healthcare to reflect the diversity of the communities it serves.

Almost a fifth of NHS staff are from black and minority ethnic groups, including about one third of nurses and doctors.

But there is still a long way to go. In some NHS careers there are compelling examples of inequality, none more so than the huge underrepresentation of BME staff in senior management. Organisations know that needs to change, but it is only happening slowly.

No form of discrimination is acceptable in the NHS and having robust HR procedures around the issue must be part of vital core business for every organisation.

Multiracial Britain

Race is one of the most significant factors behind unfair treatment and social disadvantages in British society. Organisations can help prevent this by acknowledging the discrepancy − unconscious or otherwise − and taking the necessary steps to minimise their impact both within the work place and individual’s lives.

It is well recognised that BME groups experience worse health and healthcare than their white counterparts.

Staff from this section of the population in particular have found it necessary to develop their own appropriate models and patterns of practice that they feel more closely reflect the needs of individuals from their communities.

‘It is well recognised that BME groups experience worse health and healthcare than their white counterparts’

Huge contributions have also been made by BME people in leadership within the NHS such as Lord Darzi, Sir Magdi Yacoub and Dame Karlene Davis. They are pioneers, leaders and experts in their fields of healthcare, helping inspire future generations and, shape and influence developments in clinical and management practice.

Some of the more obvious ways in which people from this section of our population have helped to shape the NHS are through the establishment of haemoglobinopathy services, culturally specific mental health services, language support, catering and engagement with the community.

There is evidence, for example, that employing staff who can communicate with people who do not speak English can and does result in a startling increase in service uptake by non-English speaking patients. Such impact will be even more important in a health setting, where the support and care required is of a personal and intimate nature.

Old concerns

However, the distinctive contribution and potential of this section of the workforce is not always acknowledged and valued. BME staff are overrepresented in “less attractive” specialisms and at lower grades, and have fewer opportunities for personal and professional development.

The barriers faced by BME staff in attaining senior management positions are also well recognised.

Research commissioned by the NHS has shown that at team level BME staff often experience greater performance pressures, are excluded from informal activities and have to put up with being negatively stereotyped.

They are also more likely to be at the receiving end of workplace harassment and bullying.

A survey by the Department of Health found that six out of 10 BME NHS staff had either experienced or witnessed racial harassment in the previous twelve months.

A study by Bradford University highlighted the disproportionate representation of BME staff in disciplinary processes, the causes of which could be a combination of unconscious bias and other factors.

Good practice initiatives

One example of creativity was the “reverse thinking” used by University College London Foundation Trust, which developed a hypothetical scenario to underpin its business case for workforce diversity.

It aimed to quantify the financial costs of not proactively managing diversity and conversely, the added benefits if it did. It found that the best approaches to equality would save it £3.8m a year.

The financial benefit came from ensuring talented people are fairly promoted, welcoming any good applicants to apply for roles, reducing the likelihood of legal action and seeing benefits in patient services.

The NHS’s BME workforce

  • Approximately 193,000 staff − 16 per cent of the NHS workforce − are from BME backgrounds.
  • Nineteen per cent of nurses, midwives and health visitors and 37 per cent of hospital doctors are from BME backgrounds
  • Only five per cent of senior managers (not including chief executives) are from BME backgrounds.

Source: Health and Social Care Information Centre

To achieve such good results, the trust would offer flexible working, confidential support, a policy on bullying and harassment, staff networks, staff road shows and focus groups.

It is also important that patients receive a multi-faith chaplaincy service, a language line “interpreting service” and patient representatives on different committees. Among other changes, its work around recruitment led to 40 per cent of the trust workforce being from BME backgrounds − exceeding the profile of the local population.

Set benchmarks

Royal Liverpool and Broadgreen University Hospitals Trust created its own benchmarking process to measure its workforce’s profile and balance more accurately.

‘The NHS is incredibly diverse and that is something that is not celebrated enough’

By comparing its trends not only with other NHS organisations, but with those outside the health service and with the population of Liverpool, the trust has established targets to improve workforce diversity and is adopting HR practice appropriately.

The NHS is incredibly diverse and that is something that is not celebrated enough. We need respect and dignity coursing throughout our organisations, between our staff and with our patients, and understanding diversity is central to that.

The NHS will keep striving to improve so we can look back with pride on a continued momentum in the area of equality, diversity and human rights. And to celebrate the impact this has made on the lives of this section of our workforce, our community and our society.

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Professor Carol Baxter is head of equality, diversity and human rights at NHS Employers