The NHS is making headway with BME and LGBT employees but many white heterosexual female staff still feel undervalued, write Adam Crizzle and Katy Edgington



In February, one year on from the publication of Sir Robert Francis’ report on the failings at the Mid Staffordshire Foundation Trust, health secretary Jeremy Hunt had this message for NHS staff: “The lesson of Mid Staffs is that the system needs to be more honest more quickly where things do go wrong… Of course, it takes time to change culture and there is much, much more to do.”

There seems to be a general consensus that a culture change is necessary, but how does one go about instigating such a shift?

On 11 June, news platform Govtoday and consultancy Hillcroft House published Who Cares for the Carers? NHS Equality, Diversity and Inclusion in England, a report examining how well NHS employees feel their employer’s equality and diversity agenda has been implemented and how valued and included they feel as part of the organisation.

Mixed impact

The report revealed that while NHS inclusion measures in England appear to have had a positive impact on black and minority ethnic, and lesbian, gay, bisexual and transgender staff, they have not been as successful for white male heterosexuals and least effective for white heterosexual females.

‘Men still constitute a majority in the leadership teams of all but 12 per cent of providers and 10 CCGs’

Despite the fact women make up 81 per cent of the non-medical workforce in the NHS, men still constitute a majority in the leadership teams of all but 12 per cent of providers and 10 per cent of clinical commissioning groups, which may account for some of the imbalances observed in the report.

Following its publication, professionals working in the healthcare sector were invited to comment.

Scope of Who Cares For Carers survey

  • The surveys were conducted in nine regions of England in 2008, 2010, 2012 and 2014, with more than 1,000 employees surveyed each time.
  • Only NHS employees were interviewed.
  • Participants were selected at random.
  • All interviews were conducted face to face.
  • No online contributions were accepted or used in the data collection.
  • For confidentiality no participant names, job titles, address or employer names were recorded.

Participants were requested to respond to the following statements:

  • Does my organisation have a policy to cover equality and diversity? Yes/no/do not know.
  • My employer promotes a culture of equality and diversity throughout the organisation. Strongly disagree/disagree/undecided/agree/strongly agree.
  • Based on my personal experience, I feel valued and included by my employer. Strongly disagree/disagree/undecided/agree/strongly agree.
  • Participants were also asked information on gender, ethnicity and sexuality.

One white female respondent, based in Herefordshire, said: “I was a partner in a practice for 21 years and always felt a little excluded and undervalued by my male colleagues.

‘I started to feel bullied to the extent that I no longer felt it safe to continue in the practice’

“In the past year, with increasing pressures, I started to feel bullied… to the extent that I no longer felt it safe to continue in the practice.

“I took [Medical Defence Union] advice and their advice was to leave. My GP appraiser couldn’t help me and my responsible officer couldn’t change the situation either.”

Unconscious bias

Many women may have had similar experiences and found that the glass ceiling is still firmly in place in the health sector. Michelle Buckenham, a clinical educator at Northampton General Hospital, asserted that she was not surprised by the results, but expressed satisfaction that inclusion work focusing on BME and LGBT groups in recent years has started to pay off.

“It’s a good sign for the NHS and recognises the efforts of so many people working extremely hard to improve inclusion,” she says.

‘Taking charge tends to be viewed as a male trait, while taking care is associated with women’

“For that reason this is something to celebrate. What needs to be looked at further is that there may be a difference between these results and in-house staff surveys. I think it’s possible that NHS employees will be more open and honest when answering an external survey than when they answer their in-house equivalents.”

Alasdair Gleed, research director at DJS Research, highlighted that unconscious bias - an area that has been the subject of much investigation in recent years - could go some way to explaining the results. The theory suggests that unconscious personal biases are often reflected in an organisations’ approach to hiring and promoting staff.

“Managers will influence how their organisation manages talent so that those being promoted to leadership positions reflect their traits and gender biases,” says Mr Gleed.

“This leads to a vicious cycle where male dominance of management positions becomes ingrained.”

It is an interesting theory to apply to the health sector, where those providing patient care are predominantly female, but managers are more likely to be male. Research by Catalyst showed that “taking charge” tends to be viewed as a male trait, while “taking care” is associated with women.

Traits perceived as feminine are often viewed as less suited to leadership roles, so when equally qualified male and female candidates apply for the same role, managers are more likely to hire the man.

Simple measures

There is a need for further research to establish why it is that women in the NHS feel undervalued in comparison to their male colleagues.

‘It’s very easy to talk the talk – the NHS has been doing that for years – but we try to walk the walk’

Ignoring the contribution made by any group is bound to impact on the ability of NHS organisations to successfully implement the recommendations of the Francis report, but there are many simple measures employers can use to address the issue.

These include introducing and maintaining clear and effective lines of communication between staff at all levels, and implementing structures to support individuals in reporting problems without fear.

Milton Keynes Hospital Foundation Trust has developed a management awareness programme for staff in bands 1 to 4 which gives them the opportunity to have mentorship and coaching. Part of the programme is about trust values developed by staff. They are used as a basis for training in attitudes and behaviours.

Empowering staff

“We won’t settle for anything less,” says Steve Melville, a general manager at Milton Keynes.

“It’s very easy to talk the talk – the NHS has been doing that for years - but we try to walk the walk as well.”

‘When all NHS staff feel valued and at ease in their workplace, this will be reflected in patients’ experience of care’

NHS leadership training should also be reviewed, with careful consideration of the effectiveness of training and the remit to include relevant issues such as the unconscious bias of management.

Patients will always be first on the agenda, but staff empowerment can have a powerful impact, giving frontline staff the freedom and responsibility to provide the best service possible.

When all NHS staff feel valued and at ease in their workplace, this will be reflected in their patients’ experience of consistently safe, compassionate care.

Adam Crizzle is managing director at Hillcroft House and Katy Edgington is the assistant conference producer at GovToday