According to NHS figures, there were 5.36 million people employed in the public sector in March 2018. Of these, over 1.1 million work directly for the UK’s single largest employer: the NHS. However, while the health service has long boasted workplace diversity in the NHS, ensuring that employee demographics continue to reflect the communities it serves is a perpetual challenge for hiring managers and HR leaders. Particularly when the quality of care and patient safety take precedence above all else.
BME progression in the NHS
The NHS workforce is more ethnically diverse than England’s general working population. According to data from the House of Commons Library, 12.5% of NHS staff identify as non-British. While 5.6% of the workforce are EU nationals, across the board, NHS staff hold 200 different non-British nationalities.
However, despite this overall diversity of talent, at the most senior levels, the percentage of staff from underrepresented groups leaves much to be desired. A study by Roger Kline, ‘The snowy white peaks of the NHS‘, examined BME progression in the health service in London. It found that although 41% of staff based in the city were from ethnically diverse background BME representation at board level stood at just 8%, with only 2.5% of chief executives and chairs identifying as non-white.
Gender pay gap
This inequality isn’t restricted to those from ethnically diverse backgrounds. Male doctors working for the NHS currently earn, on average, £10,000 a year more than their female counterparts, while NHS Improvement recently admitted that ‘more women and people from BME communities are standing down from non-executive director posts that are being appointed to replace them’.
As highlighted by the paper ‘NHS workforce race equality: A case for diverse boards‘, which was published in March 2018, the NHS is increasingly under pressure to make a good appointment. This can mean that panels ‘play it safe’, seeking candidates who have existing experience in the NHS, or those who have had the same or similar roles. The report outlines how a brief is often narrow and reductive; candidates are often required to ‘hit the ground running’. This leaves no opportunity to attract people who may require some development. It attributes this cycle of ‘recycling’ individuals – attracting people who are already in the role to the same or similar role somewhere else – as being key to a lack of significant progress. However, the value of organisational diversity shouldn’t be underestimated.
Diversity has an impact on outcomes
The recognition of the business case for diversity in the workplace is by no means a new phenomenon. No longer just a ‘nice to have’, it is now widely accepted that greater diversity really does have a positive impact on core organisational outcomes. The research most often cited as evidence was provided in separate studies by consultants Catalyst and McKinsey, both published in 2007. These studies compared the financial performance of organisations according to the gender diversity at senior levels – and both found that greater diversity had a notable impact on businesses profitability. Diverse teams have been found to be more focused on facts, better at analysing information and more likely to challenge each others’ views. Qualities, I’m sure we would all agree, are of utmost importance when it comes to healthcare delivery.
The paper ‘The Business Case for Equality and Diversity‘, commissioned by the Department for Business Innovation & Skills (BIS) and the Government Equalities Office (GEO), advises that there is no single approach that can be adapted to ensure workforce diversity. However, to be effective, equality and inclusion need to be embedded in the core strategy, not treated as an ad-hoc addition. Indeed, there is no absolute ‘right’ or ‘wrong’ process to improve how your organisation reflects wider society.
The truth is that barriers to diversity are myriad and complex at every level of an organisation, particularly in a sector where patient safety must come before all else. While the 2010 Equality Act legally protects people from discrimination in the workplace and in wider society, within healthcare there are instances where protected characteristics such as gender, ethnicity or disability can be a deciding factor when it comes to choosing the best person for the job.
Requirements of the Equality Act
Under the occupational requirement exception of the Equality Act, which was introduced in 2011, there are certain instances when an employer can specify particular characteristics for a position if the role needs to be done by a person with that particular characteristic. For example, it would be legal and appropriate to specify that only women can apply for a specific role in a clinical setting which specialises in female personality disorders. However, this type of occupational requirement is permitted only if the employer can demonstrate a robust and demonstrable link between the requirement and the job and a good business case or aim for holding the specific requirement.
In practice, this means that a severely physically disabled candidate may, for example, not be able to work in a mental health setting where they would be required to restrain patients and their disability may put patients at risk. I’m aware of a case of a mental health clinical team leader who had a prosthetic arm and could only apply for roles where there was no physical contact, as they were not necessarily aware of the force they could be putting on patients.
Similarly, if a job involves working with people from a particular ethnic group, it is not discriminatory to specify that professionals who do not have the requisite language skills may not be right for particular roles.
Aside from cases where positive action means that certain protected characteristics can be specified by employers, the secret to maintaining a workforce which is representative of the patients it serves lies in inclusive recruitment processes.
Thriving through diversity
Trusts can access the quality and diversity of talent they need to thrive if they foster an inclusive employer value proposition and focus on upskilling and developing existing teams. While changes need to be made at government level to promote healthcare careers more widely, individual organisations can also boost inclusion by selling the benefits of working in the sector – and the variety of roles available – to entry-level talent before they’ve made career decisions.
There is no doubt that workplace diversity in the NHS is an inspiration to less inclusive employers. However, to really be a beacon of excellence, we can’t take our foot off the gas. The playing field is becoming more level. For example, official figures show that 47% of very senior management roles within the NHS are held by women, while the percentage of male nurses is simultaneously increasing. However, in order to increase diverse representation at board level in the future, we must attract, engage, develop and retain diverse talent today.
