Nearly half of trusts report no BAME staff in top management tier, HSJ investigation reveals

According to data obtained from every NHS provider in England, 96 out of 214 (45 per cent) did not have any VSMs declared as being from a BAME background.

This includes several large providers, such as The Newcastle upon Tyne Hospitals Foundation Trust — where around 9 per cent of the workforce and 15 per cent of the city’s population are BAME — and Liverpool University Hospitals FT.

Nationally, around 8 per cent of VSMs are declared as BAME, compared to around 19 per cent of the total NHS workforce and 15 per cent of the population.

Three entire health systems did not have any BAME managers in the top grade within their NHS providers.

These include the health system centred in Bristol, where around 15 per cent of the provider workforce, and 9 per cent of the local population, is from an ethnic minority.

Earlier this year, Black Lives Matter protests in the city of Bristol made headlines around the world, when a statue of slave trader Edward Colston was pulled down in the city centre.

VSMs are the most senior people running the NHS day-to-day — they typically include executive directors and other senior managers with board-level responsibilities, although many do not sit on the board. 

Health systems with the lowest proportion of VSMs declared as BAME

Jon Restell, chief executive of the Managers in Partnership trade union, said the underrepresentation of BAME staff in leadership positions has “dangerously damaged” the NHS’ response to coronavirus, labelling it the “ultimate wake-up call”.

He said in response to HSJ’s research: “It is important to see what’s happening at senior management levels, taking out the distortion that you can get from including non-executive directors and medical groups. This is an important metric for us as a managers’ union.

“NHS management must reflect the diversity of the communities they serve, the diversity of their workforce and — an overlooked point — the diversity of their recruitment pools, which for very senior manager jobs are national or at least regional.”

A handful of health systems have a higher percentage of VSMs who are BAME than their local population, such as Mid and South Essex, Surrey Heartlands and Derbyshire.

Health systems with the highest proportion of VSMs declared as BAME, relative to the local population

VSMs’ salaries sit outside the Agenda for Change framework and are often determined locally, meaning there can be wide variation. However, government documents have previously suggested their average pay is around £120,000.

Although staff usually self-declare their ethnicities on forms, HSJ discovered around 6 per cent of VSMs nationally had not declared their ethnicity. This included all 21 VSMs at Pennine Acute Hospitals Trust.

Roger Kline, a research fellow at Middlesex University who designed the Workforce Race Equality Standard for the NHS, said the fact some candidates would feel reluctant to declare as BAME when applying for a job is an issue in itself.

He added: “I can’t think of a good reason why you wouldn’t want to declare your ethnicity when the NHS keeps banging on about equality and diversity as being crucial elements of good leadership.

“Why wouldn’t you want to declare your ethnicity? What example does that set? I think it sends the wrong message.”

He added there are still “far too few” ethnic minorities at senior levels in the NHS.

Largest trusts (by workforce) without any VSMs who are BAME

A spokeswoman for The Newcastle upon Tyne Hospitals FT said it has recognised the lack of diversity in its senior management team as “an area we needed to address”, and said it commissioned a detailed review of its workforce last year with a view to taking action.

The trusts in the Bristol, North Somerset and South Gloucestershire system said they recognised they have work to do to increase diversity in senior positions, but said they are making progress.

North Bristol Trust said it now had two BAME non-executives, and there had been a more than 50 per cent rise in BAME staff in other senior bands, while Avon and Wiltshire Mental Health Partnership Trust said it now had three BAME non-executives.

University Hospitals Bristol and Weston Foundation Trust said it has signed up to a national pilot to improve the experience of BAME staff.

Bath and North East Somerset, Swindon and Wiltshire said its organisations have pledged to make tangible improvements on diversity in senior positions. 

A South Yorkshire and Bassetlaw Integrated Care System spokesman said its organisations are committed to increasing diversity in senior positions and actions to address this include a sponsored development programme for BAME staff who want to progress to middle and senior-level positions.

NHS Providers’ deputy chief executive Saffron Cordery told HSJ that, while BAME representation at senior levels remains “unacceptably low”, trusts have started to tackle structural racism and racial inequalities with a “renewed focus”.

An NHS England and NHS Improvement spokeswoman said: “The NHS belongs to us all and, as part of the NHS People Plan, local NHS employers are committed to increasing BAME representation across their leadership, which we want to see.”

Methodology: HSJ sent an FOI request to every NHS trust asking for the ethnicity of their “very senior managers”, and received complete responses from around two-thirds of trusts. Figures for the remaining trusts were provided by media teams, or obtained from the trusts’ 2020 workforce race equality report and checked with media teams.