NHS takes action to tackle race inequality across the workforce

The NHS Equality and Diversity Council today announced action to ensure employees from black and ethnic minority (BME) backgrounds have equal access to career opportunities and fair treatment in the workplace.

The move follows recent reports which have highlighted disparities in the number of BME people in senior leadership positions across the NHS, as well as lower levels of wellbeing amongst the BME population.

The Council has pledged its commitment, subject to consultation with the NHS, to implement two measures to improve equality across the NHS, which would start in April 2015.

The first is a workforce race equality standard that would, for the first time, require organisations employing almost all of the 1.4 million NHS workforce to demonstrate progress against a number of indicators of workforce equality, including a specific indicator to address the low levels of BME Board representation.

Alongside the standard, the NHS will be consulted on whether the Equality Delivery System (EDS2) should also become mandatory. This is a toolkit, currently voluntarily used across the NHS, which aims to help organisations improve the services they provide for their local communities and provide better working environments for all groups.

To advance these two proposals, NHS England has agreed to consult on incorporating the new standard and EDS2 two for the first time in the 2015/16 standard NHS contract. The regulators – the Care Quality Commission and Monitor – will also consider using the standard to help assess whether organisations are ‘well-led’.

The proposal would be applicable to providers, and extended to clinical commissioning groups through the annual CCG assurance process.

Simon Stevens, NHS England’s Chief Executive and Chair of the NHS EDC, said: “We want an NHS ‘of the people, by the people, for the people’. That’s because care is far more likely to meet the needs of all the patients we’re here to serve when NHS leadership is drawn from diverse communities across the country, and when all our frontline staff are themselves free from discrimination.”

Chris Hopson, chief executive of the Foundation Trust Network, said: “It is vital that Boards reflect the diversity of local populations and the NHS workforce. We are keen to ensure that early progress is made on improving levels of BME representation at Board level and in senior leadership positions across the NHS.”

The EDC is committed to promote equality for all, ensuring no one is left behind, and will ensure that patient, service user and carer perspectives are central to its work.  It also plans to initiate work to advance equality for other groups protected by the Equality Act.

Roger Kline, Research Fellow at Middlesex University Business School and author of ‘Snowy White Peaks of the NHS’ said: “The EDC has recognised the link between the treatment of BME staff and  the quality of patient care and understands the importance of boards representing the diverse communities they serve. This proposal to implement a new standard is exactly the kind of decisive action we need to drive improvements and address inequalities across the sector. This innovative approach could have an extremely powerful impact for staff and patients alike, and has the potential to change the face of the NHS.”

Katherine Murphy, Patients Association, said: “Diversity in leadership is associated with more patient-centred care, improved patient access, experience and outcomes and higher staff morale, which ultimately is the aim for everyone using and working across the NHS.”

Scott Durairaj, Head of Patient Experience – Mental Health and Learning Disability, NHS England, said: “I was delighted to see the leadership demonstrated by the EDC, who are serious about addressing the sustained inequalities experienced by many BME staff, who are also patients too. It will be important to ensure that BME staff can be heard in the consultation and it was positive to see the EDC consider how important staff and patient experience is in coming to the proposed solutions.”

Gail Adams, Head of Nursing for UNISON and member of the EDC said: “I welcome the commitment to consultation and engagement, considering with patients, trade unions, employers and staff, what can be achieved by both options.  However if we consider these processes as architecture, the bricks and mortar is getting on with effecting change and doing this by addressing the lack of diversity in leadership and over representation of BME staff in disciplinary procedures. Whatever the process we shouldn’t and must not wait to address these two key issues, staff wont thank us and in effect this is what the service will be judged on not our processes. As an EDC we must act now by working with others to develop tools and resources for local organisations to use in partnership to address diversity gaps and review their data on staff disciplinary.  From this they must collaboratively have action plans in place to change.”

Tom Cahill, Equality and Diversity Council member and Chief Executive, Hertfordshire Partnership University NHS Foundation Trust, said: “We know there are many examples of good practice on equality in the NHS. We will look to shine a light on such practice, to make the difference that our patients, the public and the workforce need and deserve.”


  1. Equaliser says:

    Sustained Actions and Monitored Outputs

    This should be a standing item on the HR Directors groups who would need to submit regular progress reports to the EDC. These reports should be properly scrutinised as some departments like to hide behind percentages and one off initiatives. CEO networks should review previous work, current status and forward plans to ensure interventions are properly resouced!

    No amount of internal progress helps if changes are not highlighted externally, so as well as HR, communications, engagement and outreach, training and effective collaborations with voluntary and community sector are essential. The problems begin to emerge at middle management, THEY DONT GET IT because they only think within the box and dont connect with the diversity just outside their office windows.

  2. Carol says:

    Racism is rife and endemic within the NHS. Any progress that had been made has been lost and managers are free to continue to reproduce in their own image. When you turn up at interview you cannot disguise your skin color. whether they reduce your scores or tell you the other candidates were ‘more rounded’, ‘a better fit’ or pull the post, hard core racists will find a way to exclude. From application to informal chat you can be the perfect candidate but when you walk through the door you can see the visible disappointment on the face of those committed to retain the white peaks at the top of the NHS.

  3. Helen Omoregie says:

    If it’s being highlighted,that means there is a problem.Let us hope and pray that something will be done this time around.We are not in the animal kingdom where some are more equal than others.

  4. Fiona Anaman says:

    No amount of legislation will change people’s attitudes and mindsets. The degree of discrimination that operates within recruitment/promotion processes is very subtle and difficult to prove, as you always get told there was someone else better than you!

  5. Mapiye Hwekwete says:

    How can you start talking about BME being represented at Board Level if there isn’t any opportunities for them to be considered for senior operational roles.

    I work in Finance and I have seen opportunities/ jobs being created for fellow white colleagues even if they don’t have credentials/qualifications which is frustrating if you have worked through stages to acquire a qualification and you are told there will be opportunities.

    For a black person to be recognised especially in finance you have to out perform your white colleagues by 110% if they average 80% to be recognised.

    So don’t talk about inequalities if you are not ready to listen and take a serious look at the very senior managers who are promoting the inequality. That’s the stem of the story, inequality will never be eradicated in the NHS.

  6. Susan Acott says:

    I think this is a good move and should integrate with our values as a public institution whihc is there to serve a diverse population, making the most of the vast staffing resource and potential we have. I also note however that Sherwood Trust has withdrawn a job offer to a gay cleric. I think this s a bad and sad day for equality and respect.

  7. Dr Kosta Manis says:

    Could someone help me please with the definition of the “black and ethnic minority (BME)” entity?

    To start with – Why “black” is singled out? Why not “yellow, ” or “brown” and ethnic minority? Is this not in itself some sort of discrimination?

    And then, what actually qualifies someone to be a member of an “ethnic minority”? Fitzpatrick Scale recognises six different types of complexion : Pale White with Freckles, White, White to Light Brown, Moderate Brown, Dark Brown and Black.
    What about me? Does my swarthy Mediterranean skin entitles me to a membership of the BME club?

    The use of colour by non-whites does nothing else but serve the hidden agenda of the White Supremacists (plenty in the UK) and it is sad to see so many disadvantaged foreigners falling for it.

    Those of us who are not blessed with freckles should unite against our pernicious enemy : XENOPHOBIA

  8. Cynthia Davis says:

    I applaud this decision which is good not only for BME staff in the NHS, but also good for patients. Cynthia the

  9. maive coley says:

    I welcome this action because I think at long last someone out there is now taking notice that BME staff are as vaulable to the NHS, and as a HCA this at time can be very difficult to get managment to take notice of and value and respect me as part of a team. There are so many times I have been treated me so unfairley by Registred nurses, and if I complain I am told I have a chip on my shoulders and is beacuse I am not a registred nurse. This is not so I enjoy my work and I am very dedicated to all my patients, and treat my patients with dignity and respect. As a RCN HP committee member we are fighiting for all the nursing family within the NHS. There is so much inequality around I do hope that this will be sorted, which will be this strong Leadership from you all and the committment in addressing this issue. I hope equal access will be to all BME and others.

  10. Umesh Prabhu says:

    I am really very pleased to see such a strong statements from so many about race equality in the NHS. At last I can see some strong leadership from the top. But then Race Relations Act has been there since 1970s and why would anything be different this time? My only hope is leaders like Simon Stevens, Roger Kline and these are the leaders who walk the walk. Seen many leaders in NHS who talk the talk and hope this time there is something really different.

    Why it is important to address race inequality much more than any other inequality? Race is visible, colour of the skin is visible and every human being holds biases and prejudices. It is not wrong to hold bias but it is morally and legally wrong to discriminate. But sadly most of the time these discriminations are subtle, subconscious/unconscious and many good leaders and good people do not realise they discriminate because it is subconscious/unconscious and it is widespread.

    Happy staff- happy patients and contrary is unhappy staff – unhappy patients. NHS is about kindness, caring and compassion. Sadly BME staff are more unhappy in NHS as they face daily racism, discrimination, not promoted, not rewarded, not recognised and not supported to do a good job. So gradually they simply do a job. They lose compassion and patients suffer.

    On the other hand because of discrimination, club culture, old boys network and so on NHS appoints poor leaders and misses out on appointing many good leaders because of these cultural issues and hence NHS stays mediocre and patients suffer.

    If we can tackle BME inequality then it gives us an opportunity to learn and improve patient safety and quality of care and it also gives us an opportunity to improve staff well-being.

    At the end of the day it is all about our values, culture and leadership. I sincerely hope CQC, Monitor, NHS England, NHS Confederation, NHS Leadership Academy, NHS employers and every other NHS Institution will lead by examples and lead from the front to make sure that they address BME inequality in their own Institutions and top leadership position and walk the walk. It is equally important to remember for any society both positive and negative discrimination is bad and it creates ‘them and us’ culture. It is only when we all thrive in a society the whole society thrives.

  11. Mark Johnson says:

    Not before time but nice to see that the momentum is being maintained under the new management and in the new contexts – we lose too many initiatives and too much progress every time we re-dis-organise the NHS or change leaderships. Hoorah, at least one cheer! Maybe even two. Three when it is agreed and enforced, but not before. @DiversityJnl will celebrate when that is the case!!!! Up to that time, i can see why Dr Patel reserves his celebrations! It was an historic day when Admiral Byng was executed ‘to encourage the others’ and while I feel sad for him and his family, we did win the Napoleonic wars, and few Chief Executives actually die when their Trusts are hauled up for breaching a quality standard – so why not at least try a slap on the wrist?

  12. Dr Peter Patel says:

    Yet another powerless QUANGO system to justify continued inequaltities in empolyment and promotion of BME staff in the NHS. There have been several similar reports in the past and many NHS leaders have organised training meetings, workshops without any impact on addressing the issues surrounding inequality and diversity agenda. Over the last 25 years I have heard similar statements, read reports and have seen broken promises by the political parties in power as well as NHS leaders. Why cann’t we accept that there is institutional racism and discrimination in the NHS? EDS, EDS2, appointing Equality and Diversity Managers in the systems, writing Equality and Diversity Policies by CCGs and other NHS organisation is just a tokenism within the system. In a few years time we will see another similar report and another change by appointing a new organisation instead of EDC.

    Dr Peter Patel
    Partner – Development Director; Grange Hill Surgery
    Health Policy Lead with special interest in Health Inequalities, Equaltiy and Diversity – Human City Institute