sick of group think and set backs in progressing equality in the NHS

This weekend I have read my way through a challenging and important report for the NHS by Roger  Kline.

“The snowy white peaks of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England.” Middlesex University.

If leaves me troubled at the situation we find ourselves in, with data going the wrong way on numbers of Black and minority ethnic staff (BME) and women leaders in the NHS. It not just the NHS either. Statistics tell us in the top teams of the Whitehall civil servants, those who chair national committees and MPs in Parliament numbers of black and ethnic minority staff and women are reducing not increasing. This is at the same time as our country becomes more diverse and dynamic.

How long will Theresa May hold on as the token women in cabinet I wonder? She may just need those kitten heels to stamp on those trying to push her out of her cabinet room chair. How long can Sally Davies, Chief Medical Officer Keep putting up with “being the only woman in the room.” Yes, there has been outcry in the news and reinforced actively via social media.  That’s important and talk amongst current leaders including NHS Employers and the NHS Leadership Academy about needing to do something urgently is happening.

But, talk quietly and off the record to those who lead board development and undertake executive coaching in the NHS and they will tell you the sad facts.  Women who apply for CEO roles are taking 4 times longer than men to get their first post and for the rest of the board appointments look at the colour pictures on websites. 80% of the time you will guess the ethnicity and its mostly white, middle aged and male. We need action and its urgent now and Rogers work puts a loud hailer to the problem.

This isn’t just about numbers and complying with the Equality Act. Though being lawful is the first step and an important one. This is much more about the sort of NHS we are growing and developing. Can this NHS that we have been so proud of for 66 years survive the future if it does not reflect the population it serves?

How will we be truly patient centred and help people from different communities manage their own long term conditions? Where will we begin to help patients stay independent into old age and work with the capacity and capability of their families and communities to support them? That’s before we turn attention to how we maintain the morale of the staff we employ. If we do not have diverse leadership teams then we do not have people who have walked in their shoes and understand their challenges.

One of the most striking things ever said to me more than 8 years ago was a plea from a psychologist when I left a role as a provider director. She said:

“Amanda keep working full time in senior roles and keep progressing upwards in your career. Because when a mum works full time with small children at a senior level and talks about it then we all believe we could do it too.”

This is one of the problems I suspect our BME staff face, lucky to make it to an 8 grade post then they look up at the white peaks populated by tiny numbers of BME staff and many more men than women and don’t believe it could be them.

Beyond rending our garments what can we do? Well I think it has to start with all of us who are leaders and who are coaches in the NHS. As we are there at the top of the mountain and the BME staff are not. We have to make this as important as financial balance and quality of care. Monitor and CQC need to challenge us and themselves to do that too. As successful private sector companies have realised for a while now board diversity does breed success.

But, do we sit quietly in dark corners and think yes we need to do more, but surely the best people are the most talented and ambitious and they apply and secure promotions. Maybe men and white people are just better – we would not dare say that in 21st century multi-cultural Britain would we? We know it’s just not true, more than 50% medical school students are women and numbers of BME doctors continue to increase. Ability deficits are not the issue here, its opportunity and the unconscious bias or group think of the status quo leaders at the top – all of us.

My teenage son, still on his 3 weeks Easter break attends a state boarding school that holds International school status with the British Council. He therefore lives and learns with many black and Asian children (around 30% of the boarding students are Black or Asian and in rural Norfolk!) I asked my son to describe what he knew about the careers his friends wanted and he reeled off lawyer, architect and lots wanted to be doctors. It’s a hard working, high performing school. I then asked him about all the staff in the NHS and asked what does he think is going on if the leaders are not more mixed he said ITS NOT ABOUT THE LACK OF ABILITY MUM.

I’m proud my son lives, learns and grows up within a diverse community as I hope he will be someone comfortable to work and progress alongside other ambitious people of all backgrounds.

But back to the NHS, as Trust Boards finalise their corporate plans and objectives I suggest you take a look at the NHS EMPLOYERS website and their 10 top tips for diversity;

There is lots more great advice via the NHS Employers website on equality and diversity we just need to decide to act on it as leaders and ask for the help to make a difference.

Finally, in 1966 a White Irish Catholic US Senator went to South Africa, the first white US politician to do so during apartheid. While in South Africa he challenged the status quo, right there in South Africa, in the height of apartheid while Nelson Mandela was locked up on Robin Island. He didn’t see it as the responsibility of the BME community to address this, he did something himself as a privileged white leader.

He directly challenged thinking on apartheid and the organisation of life in South Africa by saying in a speech:

“But suppose God is Black, what if we go to heaven, and we, all our lives, have treated the Negro as inferior, and God is there, and we look up and he is not white? What then is our response?”

And of course the irony this Easter is that God is black, white, Asian, male, female, fit, disabled straight, gay, old and young. Because He made us all in his image and guess what, the NHS is that diverse too.

I urge us as leaders to do what we can to change this situation. Challenge ourselves, challenge our teams, and challenge our organisations to let others in, even if that means no place is left for us on the not so snowy peak.

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