More progress is needed in tackling discrimination and boosting equality for nurses across London, according to the Royal College of Nursing’s outgoing director for the capital.
In an exclusive interview with Nursing Times, Bernell Bussue expressed his disappointment at slow progress on ensuring equality kept pace with the diversity of the capital’s nursing workforce.
“There should be consequences if you don’t deliver on an equality and diversity agenda”
While he noted some improvements in this area involving ethnicity, he highlighted the need for a renewed effort as well as coming challenges on inclusivity around sexual orientation and disability.
Mr Bussue, who has just stepped down after 14 years as the RCN’s director for London, said: “I would have liked to be in a position to say we had done even better around the black and minority ethnic agenda.
“Despite all we have done, we haven’t really moved that agenda forward to the place I would have hoped,” he told Nursing Times.
“Bernell has been a dynamic leader in very difficult times for the nursing profession”
He added: “If we haven’t managed to get it right for that group, how are people with disabilities going to fare or those who have a different sexual orientation?”
Mr Bussue said he had been struck by the words of the race and human rights activist Lee Jasper, a former senior policy advisor on equalities for the ex-mayor of London, Ken Livingstone.
“One of things he said was that equality and diversity should be treated with the same importance as people treat money, meaning that the financial bottom line is where people are expected to deliver and if you don’t deliver there are consequences. Equally, there should be consequences if you don’t deliver on an equality and diversity agenda,” he said.
Nonetheless, Mr Bussue told Nursing Times that significant strides had been made since he took up the post in 2004, especially within the RCN itself in London.
“Nothing has stood still. We’ve had change upon change”
He cited one of his key achievements as having been the boosting its diversity, by increasing membership both among nurses from black and minority ethnic backgrounds and among those in senior roles.
“When I started in the regional director role, I didn’t think the RCN always gave a voice to all its members, so one of the things I was very keen to do was create a region that was inclusive,” he said.
When he first started he said BME nurses “didn’t see the RCN as a place for them”. One of the things he said he was most proud of was overseeing an increase in BME membership, with nearly half – 46% – of the 58,000 plus RCN London members now from BME backgrounds.
However, his inclusion drive was not just about boosting ethnic diversity but also about ensuring the college was catering for nurses at different levels and in different types of roles, he said.
“In the early days when I came into the job, I was staggered by the number of people in executive roles – senior nurse roles who didn’t see the RCN as the place that voiced their concerns,” he said.
“At that time, there was an organisation called First Division and a lot of chief nurses and people like that had their membership with them rather than with the RCN,” he said. “I couldn’t understand why a nurse wouldn’t see the RCN as the place for them.”
An extensive effort to engage with those in executive nursing roles means the college’s relationship with chief nurses was “very different” now and the same goes for nurses in education and academia, who were also under-represented at that time, he added.
“Over the nearly 20 years that I have been at the RCN, I have seen a lot more emphasis being put on looking at the whole variety and range of membership and how we might specify our services to take account of the needs of a wide variety of people and groups,” he said.
He said he was also “very proud” of work to engage key politicians including London MPs and members of the Greater London Assembly, as part of efforts to raise awareness of nursing issues.
However, he said he thought nursing organisations could have fought harder to keep the student bursary – the loss of which has been followed by a fall in applications to courses amid ongoing shortages of nursing staff that have hit the capital especially hard.
“There are times in this job when things need to be said that challenge other people”
He suggested that the RCN and others could have done more to explain the potentially damaging impact of losing the bursary to key decision-makers.
“A number of organisations, including the RCN, had an interest in what happened around the bursary and perhaps could have been more aggressive, more active in articulating the concerns about the loss of the bursary higher up stream,” he said.
During his time heading up RCN London, Mr Bussue has become a very well-known and respected figure among healthcare leaders, managers and nurses in the capital.
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Mr Bussue, who has a clinical background in cardio-thoracic and intensive care nursing, held senior roles in the NHS before joining the RCN as a regional officer in 1998. He went on to become the RCN’s diversity advisor, then worked as a senior regional director before taking up the director role.
Looking back on his career and time working for the college, Mr Bussue said he had witnessed a huge amount of change in healthcare and nursing – not all of it welcome or necessary. This included the wholesale restructuring of the NHS and scrapping of primary care trusts in 2011, under the health secretary at the time Andrew Lansley.
“Nothing has stood still,” he said. “We’ve had change upon change and, in some cases, it has almost been cyclical in that a change happens here and then a few years later another change comes in – but if you look back you can see the similarity.
Andrew Lansley at Confed 2009
“For me the big, big thing was the Lansley reforms,” he said. “One good thing we have seen is social care and health much closer together but some of the reforms were, I think, very unhelpful and drove a level of potential fragmentation in the NHS.
“Whatever changes we’d had before it was still the NHS moving the chairs around, but the Lansley reforms brought in something quite different and, for me, that was probably the single biggest change I have seen,” he said.
While he said he was reluctant to give advice to his successor Jude Diggins, he said forging strong relationships was vital when it came to being an effective advocate for the nursing profession.
“I don’t want to wait until there is a problem before I try to make a relationship,” he said. “That means that when there are problems, it is much easier to work them through with someone you know – and that has served me well.
“What has also served me well is being very clear that you can’t operate as an island – you have got to have other people working with you,” he said. ”Having an agenda that’s about involving and including people and gaining their trust is important, and also not being afraid to speak truth to power.
“What has also served me well is being very clear that you can’t operate as an island”
He said: “There are times in this job when things need to be said that challenge other people, but you still need to say those things. However, it’s about respectful challenge rather than being nasty for the sake of being nasty.
“Finally, always keep talking because difficult things happen in life when people resort to violence, rather than keeping a conversation going,” he told Nursing Times, ahead of his retirement party last month.
As well as championing nursing, Mr Bussue has held several non-executive and trustee roles with charities that support children and young people and is an active fundraiser.
Having just turned 64, said he was now planning on taking a well-earned break for a few months before deciding what he would like to do next.
“I’ve had lots of people asking me if I’d like to do this or like to do that, but I am refusing everything at the moment so I can see what it is like to be retired,” said Mr Bussue.
“I have always worked since I was 16 so I am going to take three or four months out,” he said. “But I don’t want to vegetate.”
“Bernell has been a true partnership worker, leading in a measured and considered way”
Mr Bussue said any future roles he took on would almost certainly be linked to nursing in some way.
“If there is anything I do that has a flavour of work then I can’t imagine it won’t have something to do with nursing,” he said. “I wouldn’t like to think I have contributed to something over the years and not be able to continue to contribute.”
RCN general secretary and chief executive Janet Davies told Nursing Times that RCN members across the capital “could not have wished for a stronger advocate”.
“Bernell has been a dynamic leader in very difficult times for the nursing profession,” she said. “For 20 years, Bernell has served the RCN and its members at every level – from being a steward and branch chair right through to senior staff – and always does so with a cool head and a cheerful smile.
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“He finished his career with a typically strong and fruitful campaign to boost pay for our members in the NHS and that will be part of his legacy,” said Ms Davies.
Among senior nurses paying tribute to Mr Bussue and his work, was Caroline Alexander, chief nurse at Barts Health NHS Trust and a former regional chief nurse for NHS England in London, who said he had played a key role in supporting NHS England’s CapitalNurse programme.
“Bernell has been a true partnership worker, leading in a measured and considered way and always thinking about the implications of decisions for and on individual nurses, the wider nursing profession, organisations and patients,” she said.
“His influence and support for CapitalNurse and nurse leaders across London has helped broker many difficult decisions over the years. He is a real CapitalNurse and an inspiration to all he works with,” she added.
“His support, insight and challenge have undoubtedly led to service enhancement across London”
Current regional chief nurse for NHS England Professor Oliver Shanley said he had got to know Mr Bussue well after coming into post in 2016.
“It became self-evident that Bernell was a highly-regarded nurse leader across the capital,” he said. “His awareness of key nursing and workforce issues are second to none. He approaches his work with a strong value base that is driven by doing the right thing for those he serves.
He added: “Bernell has been a strong partner and advocate is some key strategic areas such as CapitalNurse and improving the experience of BME staff. His support, insight and challenge have undoubtedly led to service enhancement across London.”