Workforce Race Equality in the NHS Dr Habib Naqvi NHS England March 2018

Black and Minority Ethnic (BME) staff in the NHS But… 3 BME CEOs (from ~235) 2 Exec & 4 Director of Nursing (from ~450k nurses) Less than 3% Medical Directors Less than 5% senior managers from BME backgrounds 1.4 million people work in the NHS 20% staff from BME backgrounds 28% GPs from BME backgrounds 40% of Hospital Doctors are from BME backgrounds 20% Nurses and Midwives (qualified and unqualified) Rising to 50% in London

Sir Robert Francis QC, Freedom to speak up - a report into whistleblowing in the NHS More BME staff are unsatisfied with the outcome of workplace investigations than white staff (40%:27%) BME staff are more likely to be victimised by management than white staff (21%:12.5%) BME staff are less likely to be praised by management after raising a concern than white staff (3%:7.2%) BME staff are more likely than white staff to not raise a concern for fear of victimisation (24%:13%) Impact on patient care…!

The consequences for people Disillusionment Unhappiness Depression Lack of confidence Anger/Rage Lack of belief in the system Lack of engagement and buy in Resentment POOR PERFORMANCE

The reasons for tackling workforce race inequality in the NHS THE QUALITY CASE – it ensures high quality care, patient satisfaction and patient safety THE FINANCIAL CASE – it makes good business sense THE MORAL CASE – it’s the right thing to do THE LEGAL CASE – the law says that we should NHS | Presentation to [XXXX Company] | [Type Date]

NHS Workforce Race Equality Standard The Workforce Race Equality Standard is a set of indicators that, for the first time, require all organisations with NHS contracts, to demonstrate progress against a number of areas of race equality, including a specific indicator to address the low levels of BME Board representation.

WRES phase two NHS Constitution values Enabling sustainable accountability – improving patient care for all Aim: Closing the gaps in workforce race equality across the NHS Cross cutting themes: Leadership & accountability, engagement, cultural change, outcomes, sustainability Enabling People - Meaningful engagement - Understanding narrative - Focused improvement - Resource and support Embedding Accountability - System alignment - Regulation and scrutiny - New healthcare architecture Evidencing Outcomes - Data and intelligence - Replicable good practice - Evaluation and sustainability NHS Constitution values

The 9 WRES indicators Indicator 1 Indicator 2 Indicator 3 Indicator 4 Percentage of staff in each of the AfC Bands 1-9 or Medical and Dental subgroups and VSM compared with the percentage of staff in the overall workforce Indicator 2 Relative likelihood of BME staff being appointed from shortlisting compared to that of white staff being appointed from shortlisting across all posts Indicator 3 Relative likelihood of BME staff entering the formal disciplinary process, compared to that of white staff entering the formal disciplinary process Indicator 4 Relative likelihood of BME staff accessing non mandatory training and CPD as compared to white staff Indicator 5 KF 25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months Indicator 6 KF 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months Indicator 7 KF 21. Percentage believing that trust provides equal opportunities for career progression or promotion Indicator 8 Q17. Percentage of staff experiencing harassment, bullying or abuse from manager/team leader or colleague Indicator 9 Percentage difference between the organisations’ Board membership and its overall workforce

WRES data by region I Relative likelihood of white staff appointed from shortlisting compared to BME staff Relative likelihood of BME staff entering disciplinary process compared to white   2016 2017 London 1.80 1.81 1.99 South 1.73 1.48 1.17 1.16 Midlands & East 1.52 1.34 1.56 1.28 North 1.54 1.42 1.27 National average 1.57 1.60 1.37

WRES data by region II BME staff experience harassment, bullying, abuse from patients (%) BME staff experience harassment, bullying abuse from staff (%) BME staff belief trust provides equal career opportunities (%)   BME staff experience discrimination at work (%) 2015 2016 London 29.6 30.0 28.7 29.0 69.2 69.7 14.8 14.9 South 29.4 29.5 26.8 24.9 76.0 78.8 13.9 12.8 Midlands & East 28.8 28.4 25.5 26.6 74.5 75.6 14.3 North 27.0 27.4 25.1 25.3 76.5 77.1 12.9 13.4 National average 26.5 26.3 73.8 75.5 13.6 13.8 For all indicators, BME staff have a worse experience than the national average.

Relative likelihood of white staff being appointed from shortlisting compared to BME staff by region – 2016 : 2017 The relative likelihood of white staff being appointed from shortlisting compared to BME staff is highest in London.

Ethnicity of NHS staff in London trusts by AfC bands – 2017 (Data source - National ESR) This taken is taken from the national ESR system. AfC only (excludes local pay grades)

Ethnicity of nursing, midwives and health visitor staff by AfC bands – July 2017 (Data source - National ESR) 20.8% of all nurses, midwives and health visitors are from a BME background. BME staff are overrepresented in AfC bands 4 and 5, and underrepresented in all other bands. This taken is taken from the national ESR system. AfC only (excludes local pay grades)

Ethnicity of nursing, midwives and health visitor staff by AfC bands – July 2017 (Data source - National ESR) 20.8% of all nurses, midwives and health visitors are from a BME background. BME staff are overrepresented in AfC bands 4 and 5, and underrepresented in all other bands. This taken is taken from the national ESR system. AfC only (excludes local pay grades)

Relative likelihood of BME staff entering formal disciplinary process compared to white staff by region – 2016 : 2017

Percentage of BME staff believing trust provides equal opportunities for career progression by region – 2015 : 2016

Ethnicity make-up of London population, NHS trust staff and board membership – 2017 There is a higher % of BME people working for London NHS Trusts compared to the London population. BME staff are however significantly under represented at Board level.

Ten steps: Good WRES implementation Has the organisation completed and published its annual WRES data return Have BME staff and local social partnership body been involved in discussions regarding the data Is a robust action plan produced and published - reflecting the what the data show Have meaningful discussions taken place on proposed actions in relation to key emerging issues Is there a board member responsible for the WRES (and equality)

Ten steps: Good WRES implementation Is there a BME staff group or network – are there formal arrangements to meet organisations HR team regularly How robust and complete is workforce ethnicity monitoring What steps is the organisation taking to ensure BME are supported to complete the NHS staff survey – is there a full staff census To what extent is workforce race equality, and equality in general, embedded and mainstreamed within the organisation Does the organisation link with other peer organisations to share learning and replicable good practice

Resources and further information WEB: www.england.nhs.uk/wres/ EMAIL: england.wres@nhs.net TWITTER: @DrHNaqvi