Some trusts are gaming race equality targets, says retiring NHSE lead

In a wide-ranging interview with HSJ, Yvonne Coghill also gave a “categoric no” on whether the NHS would have achieved equity in a decade, and criticised senior leaders who said they understood the equalities agenda but did not know how to deliver on it.

She said: “If they don’t know what to do, [firstly] they have not been asking the right questions and [secondly] they just don’t want to. End of. Because how much more spoon-feeding can you give these people?

“How much more do you have to give them to get them to be able to do what they should be doing anyway as leaders? When you are a leader, you’re not leading for two people or three people, you’re actually leading for the whole of the population.

“How does it work that you can support, help, develop, nurture, enable, encourage, empower your white staff so that they say, ‘This is really a wonderful organisation to be in’, and actually leave your black staff languishing behind?

“How can you put your head on your pillow at night and sleep well, drawing the big £250,000 [salary] a year, when you know that you’re only working for half of the population? That’s half of your staff and half the patients. How does that work?

“And how, pray tell, do we let them get away with it? That’s the other question.”

Ms Coghill had been the director of NHS England’s workforce race equality standard from 2015. She went on to help shape London’s covid-19 race equality strategy until earlier this month and is retiring imminently after 43 years in the health service.

She believes the NHS’ chief people officer Prerana Issar should conduct a review of WRES — which oversees a series of metrics for NHS organisations on race equality — to ensure it remains “fit for purpose”.

NHS trusts are required to report their WRES data each year as it monitors how the health service is closing the gap on workplace inequalities between white and ethnic minority staff.

It has been mandated through the NHS’ standard contract since April 2015, but its latest 2019 data has shown some indicators have either stalled or slightly regressed.

She said: “We did not review or change the indicators because we needed to measure like-with-like over time, but we made changes to the programme to put more of a focus on changes in culture over the last two years.

“Everything needs to be reviewed, to change, to evolve, as things and systems change. The WRES is a fantastic initiative that has done so much for so many people, the aim is to make it even better and more effective.”

She added: “If I were sitting where Prerana is sitting and [thought] that Yvonne Coghill is gone, and Habib is gone, and everybody else is going from the team, I would review the whole thing.

“Particularly [if] Sir Simon Stevens is going as well. Simon was the champion for the WRES. Now, if Simon goes and we get some other person, god knows… I mean who knows what’s going to happen next? We’ll see.”

Clocked on

Even more seriously, Ms Coghill also claimed to HSJ that some organisations were effectively gaming certain WRES data.

They had, she said, “found ways” around reporting their data. She used indicator three as an example, which is the likelihood of black, Asian and minority ethnic staff entering disciplinary processes compared with white staff, and called for a review to ensure the indicators are robust enough.

She said: “Organisations are really clever, and they clocked on to this. If they take it formally it will be recorded, so what do they do instead? They do things like ‘performance management’ or ‘capability statements’ for people.

“Those aren’t formally recorded but they are equally [as] draconian as any other disciplinary process because, if you are under a process for your performance, [or having a] performance review, or your performance isn’t good enough, you are still being monitored.

“You’re still being checked and it’s still making you feel like hell because you’re being watched, and it’s not recorded.

“It’s time to have a review of them [the WRES measures] and to sit down and have a conversation about them, and have a conversation about what works, and what doesn’t work, and what we need to do differently in order to get a better outcome, and how we tighten up the screws.”

Race equality progress

Ms Coghill trained as a nurse and has worked in a range of NHS management roles, including as a private secretary to the NHS’ then-chief executive Nigel Crisp in the 2000s. She was also frank to HSJ about the NHS’ progress on the equalities agenda.

It comes as the disproportionate impact of covid-19 on BAME NHS staff, patients and communities, as well as anti-racism protests triggered by the killing of George Floyd, have sparked conversations around racial discrimination.

She said: “Am I confident that we are going to change it within the next five, 10 years? Nah. Not a chance. Not a hope in hell. That’s worldwide, that’s not just the NHS, so we can put initiatives in place, we can move things slowly.

“You know that thing about turning the odd starfish so that you are at least saving a couple or saving one or two? We can do that, but will we change the whole of the society? I very much doubt it.”

Ms Coghill added: “I think there will be lots of initiatives that people are going to put into place to try and make things better in the NHS, and actually that is a good thing. We have to keep trying, you have to keep trying, but whether or not it’s going to make the changes that people want to see is the story, isn’t it? That’s the question.

“In 10 years’ time, are we going to have equity in our NHS? The answer is a categoric no. Without a shadow of a doubt. I’d change my name if that happens.

“For that to happen, you’d have to have changes in the government, you’d have to have changes in the judiciary, you’d have to have changes in society and that’s just not going to happen.”