In this article:

• The National Health Service (NHS) has one of the most ethnically diverse workforces in the public sector (Race Disparity Unit 2019). However, year after year, ethnic minority staff report worse experiences in terms of their lives and careers, when compared with white staff (WRES Implementation Team 2020). For example, ethnic minority staff are more likely to report bullying, harassment and abuse from patients and colleagues; and they are more likely to enter into the formal disciplinary process.

• People from an ethnic minority background are also under-represented in senior positions in the NHS. According to analysis carried out by the WRES Implementation Team (2020) (WRES stands for Workforce Race Equality Standard):

◦ 29.0 per cent of ethnic minority staff report that they have experienced bullying, harassment or abuse from other staff in the past 12 months, compared with 24.2 per cent of white staff

◦ 15.3 per cent of ethnic minority staff report experiencing discrimination at work from a manager, team leader or other colleague – more than double the proportion of white staff reporting discrimination (6.4 per cent)

◦ 69.9 per cent of ethnic minority staff report that they believe their trust (employer) provides equal opportunities for career progression or promotion, compared with 86.3 per cent of white staff ◦ people from an ethnic minority background make up only 8.4 per cent of boards in NHS trusts across England.

• Addressing race inequalities in the NHS workforce is critical on multiple levels. First, as we outline in this report, experiences of discrimination can cast a long shadow on ethnic minority NHS staff; the impact on people can be profound. There are also wider implications for the health service. At a basic level, inequalities are incongruous with the values upon which the NHS was founded. In addition, evidence shows that fair treatment of staff is linked to a better experience of care for patients (West et al 2011). Moreover, the NHS is in the midst of a workforce crisis and improving its performance on diversity and inclusion will play an important role in the NHS becoming a better place to work and build a career (Beech et al 2019).

• This report explores workforce race inequalities and inclusion in NHS providers. There is a considerable amount of quantitative data on this issue but a relative lack of independent qualitative research about the issue in different types of NHS organisations. In this report we discuss how three NHS provider organisations have sought to address workforce race inequalities and develop positive and inclusive working environments. We have focused on the personal accounts and recollections of members of staff and on what ethnic minority staff told us they have experienced in their working lives (see www.kingsfund.org.uk/nhs-stories). This helped us to understand the reality and complexity of culture change.

• Perhaps unsurprisingly, what we learnt was that the three case studies were still in the foothills of addressing race inequalities and making the working environment more inclusive; progress against the key metrics on race equality in the three case studies has been slow – as with the wider NHS. There were no quick solutions and therefore the three case studies were thinking strategically and preparing for the ‘long haul’ because change of this nature and at scale cannot happen overnight. We found that everyone has a role to play in an organisation’s race equality and inclusion effort – through leadership, participation or ‘allyship’.

• The case studies used different approaches to make it safer to talk about race, for example staff networks that could benefit both ethnic minority and white staff. In addition, leadership or career development programmes targeted at ethnic minority staff aiming to be promoted to more senior positions were popular. We discuss some of the advantages and disadvantages of the approaches and offer numerous points for consideration for other organisations that are working towards addressing workforce race inequalities and inclusion.

• We found reasons to be hopeful about the potential for culture change in the NHS; members of staff in the case studies were able to point to some signs of progress even if that progress did not show up in the national dataset on workforce race inequalities. This highlights the importance of looking for a range of data, including the lived experience of staff, so that you know whether or not you are heading in the right direction.

• Although each organisation’s approach to addressing race inequalities and inclusion will be defined and designed locally depending on the circumstances, the case studies offer some key learning points for the rest of the sector to consider.

◦ There are no magic solutions to an age-old issue. The work is not straightforward (for example, there can be resistance to change among members of staff) and there can be unintended consequences to implementing initiatives, which must be kept in mind.

◦ Approaches to race equality and inclusion are not ‘one size fits all’. There is a lack of proven interventions and it is down to individuals and organisations making a concerted effort at a local level to iterate the approach that ‘works’ for them.

◦ Addressing inequalities and inclusion needs to be an ongoing, ‘moment-by-moment’ activity that engages with and responds to people’s lived experiences.

You can read the complete here.