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Why are there so few BME nurses in senior NHS posts?


Nola Ishmael on why BME nurses still face an uphill struggle to get to the top of the NHS career ladder

Every so often reports on black and minority ethnic (BME) staff or service issues in the NHS are published. Each one is seized on by the media, BME organisations and the NHS itself to see what it has uncovered or recommended, and what its impact may be.

Access of BME staff to senior positions in the NHS, published earlier this year, is one such report. Commissioned by the NHS Institute for Innovation and Improvement, it is a study in stepping stones. Its stated purpose is ‘to examine the organisational barriers to black and minority ethnic staff rising to positions of authority and influence in the NHS, and to develop recommendations to promote leadership diversity’.

So what did the report tell us? It told us that BME staff comprised 10.1% of NHS management staff in 2008. This was an increase from 7.3% in 2007. However, it was below the national average of 12.1% since BME staff groups in the NHS comprised 8.3%.

The study focuses on senior managers. However, senior nursing managers, despite nurses being the largest NHS staff group, were excluded. Could it be that the findings about the status of BME nurses would have been ‘too real and too raw’ for this study?

The question is: are the barriers to BME nurses rising to positions of authority and influence different from those of other staff groups in the NHS? Or when studies such as this are undertaken do nurses not ‘fit the criteria’? I ask this because ‘fitting the criteria’ for gaining a place on the Breaking Through Top Talent Programme, for example, requires at least eight ‘yes’ answers to a set of questions that include: Can you demonstrate your experience in managing complex projects? Do you have experience in managing and delivering complex budgets? Do you have substantial senior management experience?

‘BME nurses are clinically sound so what is stopping them from being managerially competent and executively proficient? The answer is lack of opportunity’

We know that the history of BME nurses, in the main, is one of minimum progress to positions of authority or influence in the NHS. A sizeable set of evidence chronicles this unchanging situation over a decade and what could be done to improve it - Making a difference, The vital connection, Getting on against the odds, Delivering race equality and Looking back - facing the future.

It is true that in the late 1990s a number of development programmes focusing on BME staff - nurses included - were funded by the Department of Health. For example, the Beacon Organisation urged NHS chief executives to implement a programme of mentoring to assist BME staff in their development. Thankfully that legacy has remained for a few and the benefits continue.

During that period the number of BME staff in the NHS who progressed included an increase in numbers of BME nurses as directors and assistant directors of nursing. This was a ‘breakthrough’ and it was viewed by those at the top of the NHS as a step forward. How do I know? They told me then and they tell me now.

However, as with all change, reorganisation continued unabated and those nurses who had reached an NHS pinnacle, albeit not the highest one, found themselves competing for jobs. As a result this statistic fell and has not been reached since.

The Modernisation Agency through the Leadership Centre, which preceded the Institute of Innovation and Improvement, was greeted by many BME staff as giving hope to their unfulfilled aspirations and continued progress. However, when the bar for entry to leadership development programmes was raised - in that applicants had to be functioning at Agenda for Change band 8 or above - it was evident something was needed for the many BME staff below band 8. It was clear the aspiring band 7s and 6s would now not ascend higher unless they had a degree of at least 2:2, managed a complex budget or a team within a complex project. So for those who did not fit the criteria a few ‘masterclasses’ are offered.

In researching for this article I reviewed the FAQs for the Breaking Through programme. It is described as a positive action programme geared to attract and develop highly skilled managers from diverse backgrounds who have the potential to go on to achieve senior leadership positions…

A question that is occupying Yvonne Coghill, Breaking Through’s leader, is why more nurses are not applying to the programme. Could it be that they would only be signposted to the masterclasses that for some reek of ‘gesture’ and for others of window-shopping?

The NHS must recognise that talent is not always preceded by a degree but is revealed in other ways. Take me, for example. Would I have fitted all the criteria for the Breaking Through programme? Would the people who took a chance on me to perform and deliver have been in any doubt about my capabilities? I don’t think so…

The NHS needs BME staff at all levels - operational, managerial, executive and, dare I say, political. I support many of this report’s recommendations. Here is one more of my own. To paraphrase John Lennon - ‘Give BME Nurses a Chance’. They are clinically sound so what is stopping them from being managerially competent and executively proficient? The answer is lack of opportunity.

Nola Ishmael OBE was named fifth most influential nurse of the past 60 years by Nursing Times’ Diamond 20 voters


Readers' comments (6)

  • Hi i am a nurse from ethnic background, asain, i am working for the nhs and i strongly feel that there are not enough ethnic minority nurses or shall i say under represented, also feel that even you have the skills and knowledge to progress and develop, you are hindered by lack of opportunities in areas also have to proof harder than your white counterparts to able to achieve or progress. I feel that every nhs trust should set a forum or have equality section so that they can monitor recruitment, training and promotion, so that people from ethnic minorities are not penalised to gain progression, and to break the barriers. This comment is from what i have experienced myself and observed in clinical areas.

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  • I am a nurse from a BME background. I have been a band 7 for at least 4 years now despite having the necessary experience having a degree at 2:2 i feel that for me to now move on to a band 8 position my experience and skills are not enough and academically i have to complete my Masters do give me an edge. I have to keep myself updated with the Masterclass programmes delivered through Breaking Through as within our organisation this information does not filter through. It has not even been provided to other staff when I have highlighted these programmes to our OD Directorate. talking to other BME nurses it seems that many of us are in similar situations and feel that we have to work harder in order to have a chance at promotion.

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  • For many staff from BME backgrounds,it is not so much the deficits in knowlege and skills but the courage to try and not be phased by the lack of a paticular qualification.Opportunities are there and acheivements are possible if you have a good mentor and also sometimes a critical reflection on why you really want a position.As people enter the nursing profession later the expectations are huge,persons entering the areana have often had other life experiences and bring transferable skills.It is at this juncture we need to consider the succesion training needed to grow a next generation of strong leaders, for who will forge the seniors of the next 10 to 20 years?I look around and wonder if there are persons with the strengths and commitment that individuals such as Nola Ismael has given to the NHS and in paticular individuals who seek and are given genuine support on the journey.After some 30+ years in service I still have the privilege to meet and recruit such persons.They are from all differant backgrounds the variety is what makes this interesting.The challenges are many but for BME staff they need to grasp the idea of seeking positive mentoring to gain confidence in trying.

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  • How arrogant to assume that BME staff are not trying and put ourselves forward. Time and time again we have to state that it is NOT deficit in knowledge and skills but the opportunity is simply not there.

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  • I am researching this very topic for my Masters dissertation, with attention to whether BME nurses are offered, and willing to take advantage of mentoring and coaching schemes. I would appreciate any current opinions.

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  • why is there any distinction? surely it is qualifications and suitability for the job that is important. all this classification, stereotyping, distinctions and discrimination in Britain is totally ridiculous. Is there any valid reason for it?

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