Meeting the workforce race equality challenge

Stickers showing the words equality and diversity

Published today the 2016 Workforce Race Equality Standard data report presents the latest data highlighting the experiences of white and black and minority ethnic (BME) staff across the NHS.

The report shows that whilst NHS trusts still have a lot of progress to make, there are some early ‘green shoots’ of hope.  NHS England and the NHS Equality and Diversity Council introduced (WRES) in April 2015, to address, challenge and improve, well-documented and often adverse findings and experiences of discrimination across the health sector, collectively.

To date, the WRES strategy has focused on supporting NHS organisations (as well as independent healthcare providers) in understanding the intensity of the challenge within individual organisations and updating trust positions on the agenda.

Organisational responses to the nine WRES indicators of staff experience and workforce representation have held a mirror up to individual employers’ practices in supporting their BME staff – painting an accurate picture of where organisations currently are on these issues.

We built the foundations for effective WRES implementation by embedding it within the NHS standard contract, the CCG Improvement and Assessment Framework, and within the ‘well-led’ domain of Care Quality Commission (CQC) inspections of hospitals. Such system alignment of the WRES facilitated strong leadership and governance on the agenda across local NHS organisations.

Organisations across the country were supported to implement the WRES and to submit data against its nine indicators. The data returns from all NHS trusts in England were analysed and published in the first ever WRES report in June 2015.

Around the nursing and midwifery workforce overall, the proportion of BME staff at Agenda for Change (AfC) Band 5 (entry grade for qualified nurses) has remained at 24%. However, since 2014, small but potentially significant, increases for BME staff in these disciplines are observed across Bands 6 to 9.

The observed increase between 2014 and 2016 came during a period of particular concern regarding the under-representation of BME nurses and midwives above AfC Band 5; this was also a period of time when concerns about workforce race equality more generally were noted. These factors contributed towards the workforce race equality agenda becoming a policy priority for the NHS.

Looking forward, the next two years signify a critical phase of WRES implementation in helping organisations to realise the aspiration for the NHS to become a better and more inclusive employer. Three challenges will need to be met.

First, there is a need to support local threads of good practice and improving capabilities of spreading and sharing these as replicable patterns at national level – knowing, as we do, that every organisation has its own unique culture and ways of doing things.

The second challenge is to support organisations to take the learning from the WRES so that improvements can be made across the entire workforce – leading to better care for all patients; thus building shared value of inclusivity towards this agenda by fostering good relations across all groups.

Third, we know that data, regulation and compliance can help to change behaviour. However, we also need to focus upon demonstrating how these can help to change deep-rooted cultures within NHS organisations. This is perhaps the toughest challenge that we are likely to face, but once overcome, one that will go a long way in helping us to achieve workforce race equality across the NHS.

Over the next period of supporting WRES implementation, we will seek to build upon the initial work of sharing the narrative on this agenda, and on constructing the architecture for transformational change. There will be an increased need to support local threads of good practice initiatives as well as implementing whole organisation-wide approaches to the agenda.

The Next steps On The Five Year Forward View set the goal for the NHS to become a better and more inclusive employer, by making full use of the talents of its diverse workforce and the communities it serves.  On workforce race equality, trusts  – over the next two years – are expected to show year-on-year improvements in closing the gap between white and BME staff being appointed from shortlisting, and reduce the level of BME staff being bullied by colleagues.  We owe our staff and the people using NHS services nothing less.

Dr Habib Naqvi

Dr Habib Naqvi has a background in equality and diversity policy, public health, and health psychology. Habib is the Policy Lead for the NHS Workforce Race Equality Standard and is leading on the inclusion of the WRES within national policy levers.

Before joining NHS England in 2013, Habib worked on the development of national equality and diversity policy at the Department of Health, where he led on the development of the Equality Delivery System for the NHS and took the lead for coordinating the health sector’s response to the Ministerial review of the Equality Duty.

Habib has experience in academia and research, including holding a strong portfolio of healthcare research.


  1. Kassander says:

    “The Next steps On The Five Year Forward View set the goal for the NHS to become a better and more inclusive employer, by making
    *full use of the talents
    of its diverse workforce
    *and the communities it serves”*

    I live in a post-industrial, multi-cultural & multi-ethnic city
    I welcome & support fully this admirable goal
    BUT some of glaring new areas of negative discrimination
    *CCGs select their OWN choice of Lay NEDS to represent OUR communities and refuse point blank to recognise any democratic mode of selection by us
    *NHSE Citizen is excluding individual P&P from their planning groups for a new P&P Involvement & Engagement Project. They chose participants from their newly enhanced ‘Partners’ = VCS & Social Enterprises.
    The original project was closed down in mysterious circumstances over a year ago

    NHSE can reform its internal processes for all it likes but if its PUBLIC face is seen as exclusive what message does that send?

  2. David Harold Chester says:

    Your concern about social condition is heartening–it covers a wide scope of essentials. Regardless of location, lack of social progress is due to speculation in land values and its hoarding/non-use. Speculators in its value–“buy low and sell high”, having not allowed development to bloom.

    NHS policy should be for local councils to change the tax system on real estate. Local ‘rates’ (or taxes) should be based on land value and not buildings (their floor areas etc). Initially land values will drop because more land will become available, since the speculators will find this tax system spoils their profits. This will encourage entrepreneurs who previously found land access too costly, to begin operations and to hire workers for making cheaper produce than the previous big companies, who have already occupied the sites when they were low-priced, and now tend to monopolize the markets.

    A healthy town has good opportunities for earning. TAX LAND NOT BUILDINGS; TAX TAKINGS NOT MAKINGS!

  3. M Parker says:

    I fully applaud the progress being made in improving equality and diversity and having worked in two large NHS organisations both employed recruitment & promotion procedures which ensured equality and ethnicity was never a barrier to promotion.
    However the downside to this aspiration is that non-BME staff sometimes have a fear of expressing well-founded criticism of under-performing BME colleagues lest they be labelled racist and I wonder how patients and other staff can have the assurance that regardless of ethnicity all staff deliver first class services with skill, empathy and a good command of the English language and ‘tokenism’ to promote BME staff in order to fulfill a quota does not take place.

    • Kassander says:

      “It’s most difficult, if not impossible, to prove a negative.” which is what you’re asking for.

      What’s this reference to a “quota”, please? You state that you have experience of working in NHS and knowledge of certain of its employment and Equal Ops policies.
      What are these quotas to which you refer?

      What is a ‘good’ command of the English language? Perhaps a reference to IELTS scores/profiles might be useful for those whose L1 is not English?
      And for those BAME persons (And all others?) educated in UK, or thru’ the medium of English, what qualifications would you propose?

    • Kassander says:

      You assert: “However the downside to this aspiration is that non-BME staff sometimes have a fear of expressing well-founded criticism of under-performing BME colleagues lest they be labelled racist ”
      As you well know, practice in our NHS is ‘Evidence based”.
      What evidence do you have for your assertion, please? And where can your methodology and results be ‘reviewed’, please?
      If such evidence is not available, should you perhaps consider withdrawing your assertion?

      May I commend to you the following maxim:

      Semper necessitas probandi incumbit ei qui agit.