The NHS must have senior managers with the right skills to lead a health care service that is inclusive and compassionate. There is good leadership at all levels and in all teams, highlighted in the NHS’s response to COVID-19 when people in non-formal leadership roles became significant. However, we also know that progress in tackling racism and other inequalities have been slow due to a lack of leadership in the NHS. We need to recognise the areas of good leadership and celebrate all colleagues leading the way in challenging racism and creating a culture of inclusion for all.

Leaders set the tone and play a key role in influencing the culture of an organisation. To embed the core values of compassion and inclusion, leaders need to lead by example across all levels of our healthcare system. Leaders need to be engaged in a compassionate way with staff affected by such inequalities and injustice to fight systemic racism.

Leaders must also create inclusive and compassionate organisations that ensure BME staff are free from discrimination. We must continue to engage with staff affected by racism and other types of discrimination. However, leaders should stop expecting BME colleagues and those affected by discrimination to solve the problems of racism. Therefore, one of our priorities is to ensure leaders are supported and equipped to understand better how to use their leadership position and white privilege to tackle racism.

According to David Lindsay Morrison “the standard we walk past is the standard we accept”. This means that if you see poor behaviour and do not say anything or do not take action, you are part of the problem.

Acknowledgement and courage from our leaders

It is noteworthy that the Chief Executive of Birmingham and Solihull Mental Health NHS Foundation Trust, Roisin Fallon-Williams, in writing to her staff on June 5, 2020 admitted her honest and courageous stance.

In her letter, she states: “I write this to us all from what I now know and understand to be an ignorant and incompetent stance. I believed I was a good person, a compassionate and dedicated nurse and health professional who sought to understand and care for others and, in doing so, always sought to do the right thing. I interacted and responded to colleagues and service users who were victims of discrimination from a perspective of believing this to be about others’ behaviours, attitudes and beliefs, understanding that the right and expected role for me to take was one of empathy giver. Whilst I remain ignorant and incompetent, I do now better understand that I am culpable. I have been complicit. I have made individuals’ trauma worse through my words, my actions and my inactions. In this knowledge, I have a duty to educate myself and share my learning with others, work to change my behaviours, be mindful of my impact on others, seek feedback to act upon”.

This statement is a positive step in showing insight and understanding of individual responsibility. This gives us hope that we have leaders who are prepared to change the status quo.

Strategic recommendations to address inclusive and compassionate leadership

These recommendations are for short term goals for 3-6 months (S), medium term goals for 6-12 months (M) and long term goals for 12 months (L).

1. Lifelong leadership academy (NHSE&I) to support senior managers and leaders to self-assess and benchmark their skills and knowledge about how to lead on race equality and inclusion. (S)
2. Post-training/support leaders should demonstrate their understanding of the lived experience of BME staff, taking intersectionality into account. (M)
3. All managers must evidence (through their appraisal system) how they have applied their learning/skill in tackling racial inequalities affecting BME staff. This approach should be applied to all areas of inequality affecting other protected characteristics. (M)
4. All leaders must be prepared to hold others to account by challenging behaviours that demonstrate a lack of compassion and inclusion in their practice. (S)
5. All organisations to sign up to the NHS compact when launched. (M)
6. All organisations must co-develop an anti-racist action plan with their system leads. (S)
7. All organisations must have a Staff Network that is formally constituted as part of the governance structure. They must be financially supported and have executive sponsorship. (S)
8. Staff network chairs must be formally recognised as leaders in their organisations. They should get relevant leadership training, be offered protected time for their role and be part of the decision-making process. (M)
9. Each STP must appoint a senior ED&I lead working at a system level. (S)
10. WRES experts must be represented at each Systems People Board. (M)
11. ED&I leads across all organisations need to be supported and banded at a strategic level and provided with a clear career progression route. (L)
12. NHSE&I will develop a leadership development programme for ED&I leads and staff network leads. (M)
13. All organisations to sign up to the Race Equality Code 2020. (S)