According to Karl George, “action – it’s time to act. Lasting and meaningful change will only happen if we agree measurable actions and outcomes and detailed plans of how we achieve them. It would be wrong to think that focusing on race equality would be detrimental to other protected characteristics, such as gender. Action on one area results in a ‘targeted universalism’ that benefits all groups”.

‘The People Plan – action for all of us’ and the phase 3 letter from the CEO of NHS England & NHS Improvement (NHSE&I) Simon Stevens in July 2020, emphasised that racism is a problem that needs to be addressed urgently. However, that in no way diminishes the need to address the equality and inclusion needs of people with other protected characteristics.

Research on NHS staff and patient surveys in 2012 by Michael West found that the experience of black and minority ethnic NHS staff is a good barometer of the climate of respect and care for all within the NHS. So, if BME staff feel engaged, motivated, valued, and part of a team with a sense of belonging, patients were more likely to be satisfied with the service they received. This shows that addressing race inequalities does have a positive impact not only on other staff groups, but also on patients’ outcome. This strategy document focuses on improving the experience and opportunities for the BME workforce. However, the evidence demonstrates the link between improvements in workforce experience and better health outcomes for patients.

Given the complexity of addressing race inequality, the strategy’s focus is solely on improving the workforce experience. It’s important to draw attention to this link as health inequalities themselves fall outside of the remit of this strategy.

This strategic document sets out what needs to be achieved, the timeframe to reach these goals, and who will be responsible. However, it is not in itself a strategic plan. The responsibility to develop those plans rests with individual Sustainability Transformational Partnerships (STP)/Integrated Care Systems (ICS) and Organisations. It is also acknowledged that this strategy is heavily focused on secondary NHS organisations. This emphasis has been influenced by the People Plan because systems are yet to be fully established. For that reason, please note that this document will need to remain live and be adapted as we evolve to work at a more integrated system level.

Race, equality and inclusion is everyone’s business, and the responsibility to turn this strategy into reality rests with each person in the Midland workforce. Once this strategy approved, it will be available in an easy-to-read format that will be interactive and accessible online.

The strategy aims to create an anti-racist, compassionate, and inclusive working culture.

BME staff are negatively affected by structural racism. Many also suffer from day to day racism and the strategy is designed to tackle both problems. To improve the quality of work-life and remove barriers to professional development for all BME Staff. By improving the experience of BME staff, it will have a positive impact on all our workforce on how we tackle discrimination.

What does ‘anti-racist’ mean?

Anti-racists are people that are proactive in tackling all forms of racism. Some examples include:

• Take active actions to tackle racism
• Challenging colleagues that don’t act
• Confront those that act inappropriately
• Exposing your vulnerability
• Take responsibility and accountability
• Face some uncomfortable feelings
• Proactively challenge structural and institutional racism
• Start the difficult dialogue about racism
• Educate yourself about the history of racism
• Standing up as an ally
• Making your values known
• Influence others by being a role model
• Becoming a compassionate and anti-racist leader

What does ‘non-racist’ mean?

Non-racists are perceived as not actively involved in tackling racism. There are many reasons why people behave in a non-racist manner. Some examples include:

• Lack of education about racism
• Does not recognise forms of racism
• Scared of confrontation
• Anxious about standing out
• Embarrassment
• Guilt
• They do not care enough
• Not aware of their privilege
• Aware of own privilege and seek to protect it
• Acknowledging that there is a problem but won’t take active steps
• Believing that being nice is sufficient
• Lack of confidence and support

Our approach

Our approach to this strategy is built on recognising and growing inclusive leadership and talent. This strategy has been devised in response to the People Plan and influenced by wider engagement across the 11 STPSs/ICS in the Midlands.

Where possible, we have used the feedback to influence the current document. To implement this strategy as soon as possible, we have agreed to:

• Highlight the priorities for the next 3 – 12 months
• Take time to further scrutinise the feedback from the consultations and then integrate changes to modify the strategy in 12 months when it is reviewed
• Provide a further opportunity for feedback and consultation during the next 12 months
• Adapt the strategy in the light of further progress is made s with regards to the implementation of systems

For any strategy to be successful, everyone should own it. Every one of us needs to be accountable for our action or failure to act.

This strategy will demonstrate progress towards an inclusive health and social care system. We are focusing on the race agenda, but the principles embedded in this strategy will apply to all the other protected characteristics set out in the Equality Act 2010.

Under pinning principles

The proposed recommendations in this strategy are based on the three principles of challenge, education and support. These principles are embedded in all our actions. We believe that if these principles underpin the actions we take, they will make a significant shift in progressing equality and inclusion across all protected characteristics in the Midlands in the next 12 months to 5 years.

The two most important drivers that will help us embed those three principles across all our actions are leadership and accountability.

1. We need to have the right and diverse leadership at all levels within our health care system. Senior managers need to lead by example.
2. Ensuring that we have accountability at all levels is key to the success of this strategy. Anyone who is not prepared to be accountable for progress, or demonstrate a lack of progress, are not leaders and cannot lead.

One way for us to know that this strategy is successful is when staff tell us we have achieved our goal.

Using the principles to lead with inclusion and compassion

• Support each other by being honest, open, inclusive, and transparent
• Challenge with care and compassion – carefrontation. We all need to challenge ourselves first before
• Educate self and others – you don’t know what you don’t know, so we challenge others

It’s not good enough to be non-racist. Every one of us must take action to become anti-racist.

Midlands WRES 2020 data headlines

• 20.4% of our workforce in NHS Trusts in the Midlands are from a BME background
• 7 out of 41 Trusts have no BME representation at Board level
• There are 45 BME non-executive board members and 25 BME Executive board members in the Midlands
• Overall BME makeup of Midlands Boards 11.2% –second-highest region after London
• Second highest region after the North East for BME staff experiencing harassment and bullying from colleagues/staff

WDES 2019 data in the Midlands

This data is from the national WDES data report 2019.  When the WDES 2020 data report is published, this section will be updated.

Disabled Workforce representation in the Midlands:

• Disabled staff at Bands 1-4 representation is 3.69%
• Disabled staff at Bands 5-7 representation is 3.91%
• Disabled staff at Bands 8a-8b representation is 2.99%
• Disabled staff at Bands 8c-9 & VSM representation is 1.70%

Feedback from listening events in the Midlands – October 2020 

The regional Midland listening Covid-19 events highlighted these themes:

• Health and wellbeing
• BME staff network: support, engagement, decision making
• Diversity and representation at senior level
• Structural and everyday racism and bias
• Leadership, culture and accountability
• Speaking up
• Communication
• The above themes were consistent and reflected the experience of BME staff across England

Challenges in the Midlands

• Addressing institutional racism
• Measuring and tracking meaningful progress
• Embedding ED&I in mainstream work
• Stop bullying and harassment
• Making Race Equality everyone business