Three and a half years after Roger Kline published the seminal ‘Snowy White Peaks’ report into the discrimination in governance and leadership in the NHS, Sir John Parker has published his Report into the Ethnic Diversity of UK Boards. Both reports draw exactly the same conclusions which can be summarised into one sentence; the diversity of our most senior people in our country does not reflect our population, and we are the worse for it.
Diversity is a crucial part of an innovative and forward thinking organisational culture. That is not just cultural, ethnic or gender diversity but also diversity of background, perspective and opinion. As revealed by Chancellor in the Autumn Statement the UK economy has fallen out of the top 5 of world economies and so a move away from homogenous thinking on Boards, which can reduce the effectiveness of decision-making and as such stifle growth and innovation, is a key factor of in the commercial success UK organisations.
The Kline report’s opening statement was a stark warning to the NHS, “There is increasingly robust evidence that a diverse workforce in which all staff member’s contributions are valued is linked to good patient care.” The report, which focussed on NHS Trusts in London, highlighted that in 2014 only 8% of Board members were from a black or minority ethnic (BME) background, which had reduced from 9.6% in 2006. Similarly, the Parker Review found that in 2017 only 8% of FTSE 100 Directors are from a BME background and of those only 2% are UK citizens. This is a shocking level of under-representation when 14% of the country are from a BME background.
So what is going wrong?
Looking at the latest NHS Workforce Race Equality Standard (WRES) results although there has been slight improvements in the recruitment of nurses and midwives, the NHS has not improved over the past three years with only 6.1% of non-clinical very senior managers being from a BME background. The same report also shows that white candidates are 1.57 time more likely to be appointed from shortlisting and in some cases up to twice as likely. This suggests that panels are still recruiting in their own image and unconscious (or conscious) bias exists. In a time when the NHS needs to attract the best talent to be at its most innovative and productive, it seems to be going in the wrong direction. This will need to be quickly addressed if the NHS is going to realise the potential it has nesting inside its 1.2million strong workforce before it is too late.
The NHS staff survey shows every year that a high proportion of staff do not feel that there is equal opportunities to career progression and many staff cite this as reasons for leaving NHS organisations. There is enough data telling us about the problem, what needs to be different is what we do about it?
What can we do to change?
If the NHS is to be serious about making a difference, it is time to take a radical and sustained approach to creating compassionate and inclusive cultures. For this to make a difference notable change will need to be role modelled from the Board-level so as to ensure the right conditions are created throughout the whole organisation.
Taking an action-based approach that demonstrates commitment to improving this situation over a longer period of time will be the most visible and important thing that organisations can do. Really paying attention to supporting the development of a pipeline of talent for individuals across the organisation from a range of diverse backgrounds that go further than race and gender so as to include social background, generational perspectives and different ways of thinking would be a step forward in creating the inclusive cultures that will foster talent across all levels of organisations.
The Parker Review makes three recommendations which can equally apply to the FTSE as well as the NHS:
- Increase the Ethnic Diversity of UK Boards – each FTSE 100 Board should have at least one director of colour by 2021; the same for each FTSE 250 by 2024
- Develop candidates for the pipeline and plan for succession – members of FTSE 100 and FTSE 250 should develop mechanisms to develop and promote people of colour within their organisations in order to ensure over time that there is a pipeline of Board capable candidates. This includes the recommendation of mentoring schemes and to grow internal talent through subsidiaries.
- Enhance transparency and disclosure – a description of the Board’s policy on diversity should be set out in the company’s annual report and should include description of company’s efforts to increase, amongst other things, ethnic diversity, particularly at Board level. Where the company does not meet the Board composition recommendations by the relevant date this should also be disclosed.
These sound easy but will take a change in attitude from current Boards and senior managers at the top of organisations, including the NHS. Recognising that there are barriers to progression, seeking to understand these and take action to remove the things that get in the way will take a commitment and energy that previously has not been universally applied.
There are some examples of organisations, both public (including the NHS and Universities) and private sector, who have been at the forefront of striving to improve diversity published by The Royal Society as part of their campaign for developing diversity in science. Within these case studies there are some great examples of mentoring schemes; flexible working approaches and development programmes that we could all learn from.
The NHS turns 70 next year at a time when it is going through its most difficult time, struggling to recruit and retain the staff needed to continue to deliver the high quality healthcare for our population. The development of a compassionate and inclusive culture will be the single most important thing that NHS organisations can do to ensure that the NHS remains an employer of choice and continue for the next 70 years.
About the author
Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust, one of the largest integrated teaching hospital and community services trust in the NHS with 15,000 staff and £1.4bn turnover.
Sarah is passionate about creating a culture of compassion and inclusion in the NHS.