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Progress made on race equality in NHS workforce, but slowly

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An increasing proportion of senior posts are being filled by people from black and minority ethnic (BME) backgrounds but nurses still face “an uphill struggle for equality”, warn nursing leaders.

NHS England’s latest report on race equality in the health service, which assesses how well trusts are performing against the new Workforce Race Equality Standard (WRES), shows signs of progress when it comes to BME nurses achieving higher pay bands.

“There is still a lot to be done to ensure we see more BME nursing and midwifery staff taking on more senior roles”

Jane Cummings

However, it also reveals that BME staff are less likely to get help with career progression or be appointed when shortlisted for jobs, and are more likely to face formal disciplinary procedures and experience bullying and harassment and abuse from colleagues.

At least one in five nurses is from a BME background, yet the data shows BME nurses and midwives continue to be “seriously under-represented” in more senior roles at band 6 and above.

A quarter of all BME nurses, midwives and health visitors in 2017 were at band 5. However, there were encouraging increases in the number of BME nurses and midwives in more senior roles between 2016 and 2017, noted the report. These include:

  • 6.8% increase at band 6 – 1,347 more BME nurses at this level
  • 6.4% increase at band 7 – 439 more nurses
  • 9.1% increase at band 8a – 96 more nurses
  • 2.4% increase at band 8b – 5 more nurses
  • 29.1% increase at band 8c – 16 more nurses
  • 63.6% increase at band 8d – 7 more nurses

The report suggests these increases may be, in part, down to an increased focus on tackling inequality in the NHS, including the introduction of the WRES.

“While it is not possible to ascertain the exact reasoning behind the observed increases in the number of BME nurses and midwives above band 5, the introduction of the WRES in April 2015, as well as natural career progression, would certainly be contributing factors,” said the report.

“However, there is still much more progress to make for this critical part of the NHS workforce,” it stated.

Positive findings that were highlighted by the report included an 18% increase in very senior managers from BME backgrounds – up from 212 in 2016 to 250 in 2017.

“BME staff are facing a slow uphill struggle for equal access to career opportunities”

Tom Sandford

The report also confirmed that an increasing number of trusts had more than one board member from a BME background, with 25 now represented at board level by three or more people from BME communities.

However, the report also revealed the scale of the continuing challenges to progress, with BME staff 1.37 times more likely to enter a formal disciplinary process than white staff – although this is an improvement on the 2016 figure of 1.56.

In addition, BME staff were more likely to enter the disciplinary process than white staff at two thirds – 65.9% – of trusts.

In as many as 55 trusts – just under a quarter – BME staff were more than twice as likely to face disciplinary proceedings than white counterparts.

The report also showed that BME staff remain significantly more likely to experience discrimination at work from colleagues and their managers compared to white staff, with rates at 14% and 6% respectively.

Meanwhile, BME were generally more likely to have experienced harassment, bullying or abuse from colleagues in the past 12 months, with this being the case for 26% – down slightly on 27% the previous year.

“The NHS has a particular duty to be fair and supportive for all our employees”

Simon Stevens

Likewise, there were ongoing disparities in opportunities for career progression, with white staff 1.22 times more likely to access non-mandatory training and continuous professional development (CPD) than BME staff.

Meanwhile, the report found white job applicants who were shortlisted for positions were 1.60 times more likely to be appointed than BME shortlisted applicants.

However, there is evidence that schemes to tackle discrimination and support BME nurses and others to achieve their full potential could have a significant impact.

A separate report, published by NHS England and based on steps taken by six trusts that were performing well on the WRES, found “improvements in the career progression for BME nurses and midwives across the NHS are entirely possible”.

The report – titled Enabling BME Nurse and Midwife Progression into Senior Leadership Positions – concluded that it was important to have a clear strategy with “aspirational targets” for boosting workforce diversity that were regularly monitored.

Targeted programmes to develop the skills and confidence of BME staff as well as coaching, mentoring and job shadowing schemes could also be effective while other key steps include reviewing interview processes and listening to BME staff via focus groups.

Meanwhile, trusts doing well on the WRES standards were also working with the Royal College of Nursing on its Cultural Ambassador Programme, which is aimed at supporting employers to tackle discrimination.

The scheme places specially trained staff from a BME background onto investigations and disciplinary panels where a BME member of staff is involved. In the West Midlands, where the programme was first implemented, there has been a reduction in the level of sanctions and investigations involving BME staff.

The RCN is also working to boost equality in the capital – where lack of representation continues to be a big issue despite a high proportion of BME frontline staff – through a specific project called the London Inclusion Solution.

In addition, the WRES report showed some improvements in London’s performance, including a reduction in the likelihood of BME staff entering formal disciplinary procedures.

In 2016 BME staff in the capital were twice as likely as white staff to go down this route, but that dropped to 1.8 times as likely in 2017.

Tom Sandford

Tom Sandford

Tom Sandford

Responding to the report, Tom Sandford, the RCN’s director for England, said there was no room for racism in health and social care, and “certainly no place for it within the nursing profession”.

“BME staff are facing a slow uphill struggle for equal access to career opportunities and to be treated fairly in the workplace,” he said.

“When there is racial inequality in the workplace it can affect patient care – it is now time for employers to take robust action to address this systemic problem across the sector,” he added.

NHS England chief executive Simon Stevens said building a more representative workforce was important “both for hard working NHS staff and for the diverse patients and communities we serve”.

“As the largest employer in Britain and one of the biggest in the world, the NHS has a particular duty to be fair and supportive for all our employees,” he said. “Today’s assessment shows important improvements for our BME staff, but it’s also a clear reminder of the hard work still ahead.”

NHS England/NHs London

England’s chief nurse to oversee health service in the capital

Jane Cummings

Chief nursing officer for England Jane Cummings, the senior responsible officer for the standard, said she was pleased to see some improvements but also stressed the need for further effort.

“I am happy that for the second year in a row, there is evidence of some continued improvement in the WRES data of some trusts and that we have seen a sustained increase in the number of BME nurses in senior posts,” she said.

She added: “There is still a lot to be done to ensure we see more BME nursing and midwifery staff taking on more senior roles. For the first time, the London region has made some slight improvement, which I hope to see continue in the coming years.”

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