The gaping hole in minority ethnic leadership

We have grown our annual list of Black, Asian and minority ethnic leaders to mark its sixth birthday. It now covers 75, rather than the previous 50, leaders.

This move reflects a belief by the list’s judges and supporters that strides in recent years mean there are now more BAME leaders with serious power – a reason to pause and celebrate.

The list, and the process of compiling it, suggests that at board level in provider trusts the barriers that have blocked BAME leaders are crashing down (or that the individuals are leaping even higher to jump them).

Thirteen trust chief executives make the list, against nine last year and four the year before. Add trust chairs and executive directors (especially HR/people directors), and the provider contingent is easily the largest yet. There were numerous others who might have been added to the list.

The increase in BAME leadership is necessary, but not sufficient to keep pace with the rapidly-changing wider workforce. Minority ethnic staff represent 30.7 per cent of the NHS provider workforce at the most recent count. NHS England figures suggest BAME trust board membership rose last year too – but only to 17.3 per cent; and just 12.8 per cent among executive directors.

Even more progress has been made by the regulators. Three of the Care Quality Commission’s chief inspectors feature on the list, alongside senior figures at the Nursing and Midwifery Council, the General Medical Council and the National Institute for Health and Care Excellence.

The gaping hole in ‘the new centre’

But elsewhere there are reminders that change does not always equal progress – and that the job is far from done. There is still only one integrated care board CEO with a minority ethnic background (Nnenna Osuji, in North East London).

Fifteen names among the 75 are linked to NHSE, more than ever. But just one of these (Meghana Pandit) sits on its national executive team, and she is part-time and due to imminently return full time to her trust. The regional chair/director tier is no better.

Looking to the future, the gap is even starker. The fledgling joint executive team across NHSE and the Department of Health and Social Care, which is meant to form the basis of the leadership of the ‘new centre’ next year, has virtually zero racial diversity (Birju Bartoli was named as interim emergency care lead days before we published, but the future status of that role is unclear).

There is some evidence in recent years of a fall in the number of NHS leaders on the list with dedicated equality, diversity and inclusion job roles – likely an echo of the move away from this approach among politicians and policy makers.

There is a respectable case for that shift, if dedicated posts give way to diversity in the jobs that actually run things, and to mainstream accountability. Ministers have said they want the NHS held to account “for outcomes, not just inputs and workshops and posters”.

But the change comes as cuts and restructures tear through the layers of NHSE, ICBs and much of trust management, and it compounds the risk of diversity being lost; and pipelines of talent being destroyed. Restructure, cost-cutting and short-term expediency are classic excuses to drop the ball on equality.

The ‘new centre’ is very much still in flux – just ask the thousands in NHSE waiting to hear who their employer, and their CEO, will be in seven months’ time – so there is time yet for improvement.