NHS drive for diversity in key roles ‘going backwards’Megan Orito
NHS drive for diversity in key roles ‘going backwards’.
Study finds fewer woman and BME people in key jobs at NHS trusts, despite initiatives to improve representation.
The declining number of people with a BME background in key positions is a setback for the NHS England chief executive, Simon Stevens. Photograph: HANDOUT/Reuters
Fewer women and people from black and minority ethnic backgrounds are being given key roles running NHS trusts, prompting claims that the health service is going backwards on diversity and inclusion.
The proportion of chairs and non-executive directors of NHS trusts in England who are from an ethnic minority has almost halved from 15% in 2010 to just 8%, research shows.
The proportion of women in those posts has also fallen from 47% in 2002 to only 38%, despite a flurry of initiatives to improve female as well as BME representation in senior NHS roles.
The findings are contained in a report by the NHS Confederation, which represents 85% of local health service bodies in England.
“The progress and gains made in the early 2000s towards a more diverse board leadership in NHS trusts has gone into reverse or made no progress,” the report said.
“As a community of leaders, chairs and non-executive directors are often not representative of the communities they serve and the staff they govern.”
The 38% of chair and non-executive director roles filled by women is in stark contrast to the fact that overall 77% of the NHS’s 1.3 million-strong workforce is female.
Similarly, while just 8% of those posts are held by those from an ethnic minority, overall 19% of NHS personnel are from a BME background.
The gender gap in the NHS has widened between 2002 and 2017 resulting in the dominance of males in non-executive roles.
Almost half of the 240 NHS trusts do not have even a single BME board member, according to separate NHS data collected to monitor progress against the service’s workforce race equality standard.
The declining number of people with a BME background in key positions is a setback for the NHS England chief executive, Simon Stevens. He has made improving BME representation a key priority during his five years in charge and warned of the dangers of NHS trusts failing to better reflect their local communities.
The data shows that the NHS is failing to honour the spirit of laws designed to improve female and BME representation, according to the report, which says: “Equality, diversity and inclusion is an area that the NHS needs to make significant progress in to reflect the spirit of the equality and diversity legislation and the NHS’s stated ambition to create a more diverse leadership.”
Danielle Oum, the chair of Walsall Healthcare NHS trust and co-chair of the confederation’s BME leadership network, said: “Diversity on boards is important for diversity of thought and the avoidance of groupthink. It’s particularly key for the NHS due to the make-up of its workforce and the population it serves.”
She warned that under-representation of both groups could become even worse in the next few years as a result of the ongoing structural upheaval that NHS England is overseeing as it creates a wave of new bodies called integrated care systems
The report blames the widening gaps in female and BME representation on the abolition in 2012 of the NHS Appointments Commission and the move, begun during Tony Blair’s premiership, to allow some NHS trusts to become semi-independent foundation trusts.
The Appointments Commission sought to ensure gender balance and better BME representation when selecting people for key roles. Selection now is done by trusts themselves, with input from the finance and governance regulator NHS Improvement.
Foundation trusts appoint their own board members, in conjunction with their governors, but without any say from an independent agency.
The confederation called for an urgent overhaul of the appointments procedures for such posts. However, “significant barriers” in the way of progress include “groupthink” decision-making by independent board advisers, governors and executive search companies and selection criteria valuing commercial and financial skills ahead of those needed to ensure the collaboration and transformation that the NHS plans, it added.
NHS England highlighted that growing numbers of trusts have at least two BME board members. Boards include executive directors, which the confederation did not analyse, as well as non-executive directors.
“The NHS long-term plan restated our commitment to making our boards and leadership more representative of the workforce and wider society,” said Yvonne Coghill, its director of workforce race equality standard implementation.
“Thanks to the workforce race equality standard programme we have seen a steady increase in the number of NHS trusts that have more than one BME board member, and a new model employer strategy is providing further intensive support to improve diversity at all levels of local NHS organisations.”
Joan Saddler, co-chair of the NHS equality and diversity council, said: “This report must be a wake-up call for a health service which is heading in the wrong direction and becoming less diverse at board level. That is not right for patients and staff working in NHS organisations.”
The NHS has pledged to tackle the under-representation of both groups since the 2000s, but progress has been limited or non-existent. For example, research in 2014 by Middlesex University academic Roger Kline about the NHS’s “snowy white peaks”, found that the proportion of BME people on the boards of trusts in London was small at 8% and falling, despite the city’s significant cultural diversity.
NHS England’s chair and vice-chair, who is also a non-executive director, are both white men. Three of its five other non-executive directors are women and two are men, one of whom is from an ethnic minority.
Ifti Majid, chief executive of Derbyshire Healthcare trust, said: “The time for passively accepting inequality has long passed.”
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