1. Building Inclusive Leadership and Diversity Measurement- and its links to NHS standards Peter Ryan University of Bradford 1 st June

2. Aims To report on two recent studies on Race and Disability in the NHS Workforce as exemplars of measuring diversity To reflect on the complexities of operationalising research data into NHS workforce standards To explore the role of an inclusive approach to leadership in terms of enabling standards to influence the NHS workplace ‘culture and practice’ in a proactive, creative, inclusive manner To introduce the Disability as an Asset appproach

3. The studies Klein (2014) Snowy White Peaks of the NHS: A survey of discrimination and leadership and the potential impact on patient care in London and England Ryan & Edwards (2016) Research on the Experience of Staff with Disabilities in the NHS Workforce

4. The data base NHS Staff survey 2013 & 2014 The 2014 Staff Survey involved 287 NHS organisations in England. Over 624,000 NHS staff were invited to participate using a self- completion postal questionnaire survey,or electronically via email. Received responses from 255,000 NHS staff, a response rate of 42% (49% in 2013). All full-time and part-time staff who were directly employed by an NHS organisation on September 1st 2014 were eligible, unless on long term sick leave..

5. The Standards WRES: Workforce Race Equality Standard (2015) WDES: Workforce Disability Equality Standard (2017) * * Planned implementation date

6. Snowy White Peaks: key findings 8% of NHS Trust Board members from a BME background in 2014, reduced from 9.6% in 2006 Proportion of chief executives and chairs from a BME background decreased from 5.3% to 2.5% in 2014 40% of London NHS Trust boards had no BME board members at all

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8. WRES: the Context The ‘Snowy White Peaks’ 3 highlighted the substantial under-representation of ethnic minority groups in a sample of London NHS Trusts Action taken: The implementation of the Race Equality Standard (WRES) The EDC agreed to scope a ‘programme of action’ around disability, gender and sexual orientation The EDC and NHS Employers commissioned research exploring the experiences of disabled staff in the workplace WRES metrics drafted based on the research findings 3 The 'snowy white peaks' of the NHS: a survey of discrimination in governance and Leadership Klein 2014

9. WRES cnt’d The Workforce Race Equality Standard was introduced in April 2015, after engaging and consulting key stakeholders including other NHS organisations across England. It is now included in the NHS standard contract, starting in 2015/16and included in the 2016/17 NHS standard contract

10. WRES: the Metrics % staff reporting bullying, harassment or abuse from patients, relatives or the public % staff reporting bullying, harassment or abuse from staff % staff who believe that trust provides equal opportunities for career progression or promotion % staff experienced discrimination at work from manger/or team leader

11. Metrics 11 Oxleas WRES - Metrics 1 White staff are 2.6 times more likely to be at the most senior levels of the organisation 2 BME staff are 3 times less likely to be appointed from shortlisting compared to White staff 3 BME staff are 3.6 times more likely to enter the formal disciplinary process compared to white staff 4 BME staff are 1.6 times more likely to access non mandatory training and CPD than white staff 5 BME staff saying that they have experienced harassment, bullying or abuse from patients, relatives or the public is 9% higher compared to White staff 6 BME staff saying that they have experienced harassment, bullying or abuse from other staff is 4% higher compared to White staff 7 BME staff are 4% less likely to say that the trust provides equal opportunities for career progression or promotion compared to White staff 8 8% said that they had experienced discrimination on the basis of ethnic background from their manager or other colleagues 9 The gap between the Board and the local BME population is 9%

12. Oxleas: WRES – Corrective Actions 12 Coaching and Mentoring for BME staff BME Coaching Scheme: 1:1 Coaching provided by independent organisation BME Mentoring Scheme:1:1 Mentoring provided by the Executive team WRES: Review Independent contractor Interviews with key staff and review of data with recommendations BME Network involved in all decision making Disciplinary Cases Annual case by case review by BME Network Chair, Equality lead and Head of Operations Audit of queries to HR where managers ask for advice on disciplinary cases

13. WRES Impact (Oxleas) Strengths Increased partnership working with the BME Network Executive Wider exploration of data and metrics Series of new actions Looking for good practice examples Greater understanding of the disparity between White and BME staff Challenges Difficult to find out why and what actions will make a difference Equality – 9 protected characteristics Cynicism 13

14. WRES first data analysis report (May 2016) Higher percentage of BME staff *(50% )report the experience of harassment, bullying or abuse from staff, than White staff *(27%), regardless of trust type or geographical region. Ambulance trusts are more likely to report this pattern. BME staff are generally less likely than White staff to report the belief that the trust provides equal opportunities for career progression or promotion. This pattern is strikingly widespread regardless of type of trust or geographical location. *Acute trusts

15. WRES (2016 cnt’d) BME staff are more likely to report they are experiencing discrimination at work from a manager, team leader or other colleague compared to White staff, regardless of trust type or geographical location.

16. Research contributing to WDES Two research studies: NHS Employers (2015) DRUK (2015)

17. Disability Rights UK- qualitative findings Interviews – in-depth, non-standardised, n=13 Majority had disability-related leave not listed separately – triggering sanctions or reduced A/L Patchy implementation of Disabled Staff groups Failure to understand and use Access to Work Poor practice around delivery of E & D training Fear around disclosure - compounded Managers’ mixed abilities to support disabled staff Benefit of lived experience at planning and delivery

18. NHS England: Research on the experience of staff with disabilities within the NHS Workforce (Ryan, Edwards et al 2015) Aims/Focus of the Report : Representation of disabled people in the NHS What is staff with disabilities’ representation at all levels of the NHS and covering different types of disability? NHS survey /ESR disparity Why is there a disparity between the proportion of staff who declare a disability on the Electronic Staff Record System and of those who declare a disability on the anonymous NHS staff survey? Support for disabled staff How well are staff supported who become disabled during the course of their employment? Is there a process for recording this on the staff survey? Appraisal rates for disabled staff What are appraisal rates for staff with disabilities compared to non-disabled staff? Access to training and development Do staff with disabilities have similar levels of access to training and development as non-disabled staff? Making reasonable adjustments How well do NHS organisations make reasonable adjustments for staff with disabilities, from the recruitment process to the end of employment? Effectiveness of the ‘two ticks’ symbol What difference does the ‘two ticks’ symbol make to recruitment and employment?

19. NHS staff survey definition ‘having a long-standing (meaning that it has lasted, or will last, at least 12 months) illness, health problem or disability’. Much broader than Equality Act (2010) definition as: ‘A physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities’.

20. Proportion of disabled staff 17% in the NHS Staff survey 18% white staff; 13% BME staff 3% in ESR NO diversity of disability Not possible to disaggregate as to disability type

21. Differences in quality of support between staff with and without disabilities Operationally defined by linking NHS (2014) survey questions: Q21&23: What are the levels of bullying and harassment? Q15b: How far do staff feel ‘Pressure to work when feeling unwell’? Q22: Do staff feel their organisation acts fairly with regard to career progression? Q8 & 9: What levels of job satisfaction do staff report?

22. Differences in ‘quality of support ‘ between staff with and without disabilities Staff with disabilities felt: More bullied, in particular from their managers and colleagues (12 percentage points higher) BME staff responded that they experienced bullying and harassment by their managers 4 percentage points more than white staff More pressure from managers to work when feeling unwell (11 points higher) Less confident that their Trust acts fairly with regard to career progression (8 points difference) Less job satisfaction (6 points difference)

23. Discrimination Does your organisation act fairly with regard to career progression / promotion, regardless of ethnic background, gender, religion, sexual orientation, disability or age? -13% (BME) How many times have you experienced discrimination on grounds other than disability? + 20% (BME)

24. Appraisal Frequency – no difference But, substantial differences in the value of appraisal: 7 points fewer disabled staff felt that appraisals improved their performance. 9 points higher felt that work is not valued by their organisation

25. Reasonable Adjustments “Did the employers make adequate adjustments to enable you to carry on your work?”: “Yes” – 40% “No” – 14% “No adjustment required” – 46% White British staff with disabilities report the highest rate of adequate adjustments made by their employer. BME have consistently lower rates than white British, the relatively small groups of Bangladeshi and ‘Other black background’ staff report much lower rates

26. The case for WDES Strengths Research evidence (regression analysis) : NHS survey data shows disability is the single greatest factor with respect to bullying and harassment and the other negative reported findings Natural justice – needs a mandated Standard to positively correct for the negative work experience of NHS disabled staff Increased partnership working with Disability Networks across NHS Wider exploration of data and metrics Series of new actions Looking for good practice examples Greater understanding of the disparities between disabled and non-disabled staff Challenges Bureaucracy and workload complications and additions should not be under-estimated Cost implications Stigma AND cynicism: why do we need another standard etc?? Co-ordination/iteration with WRES? 26

27. Metrics 27 Proposed WDES Metrics (any given year) 1 Percentage of disabled staff in Bands 8-9, VSM (including executive board members and senior medical staff) compared to the percentage of disabled staff in the overall workforce Non-disabled Disabled 2 Q20b: In the last 12 months, how many times have you personally experienced harassment, bullying or abuse from your manager/team leader or colleagues? Non-disabled Disabled 3 Q15b: In the last 3 months, have you felt pressure from your manager to come to work despite not feeling well enough to perform your duties? Non-disabled Disabled 4 Q22: Does your organisation act fairly with regard to career progression regardless of ethnicity, gender, religion, sexual orientation, disability or age? Non-disabled Disabled 5 Q8g: How satisfied are you with the extent to which your organisation values your work? Non-disabled Disabled 6 Q3e (Appraisal): Were any training, learning or development needs identified? Non-disabled Disabled 7 Q3f (Appraisal): Did your manager support you to receive this learning and development? Non-disabled Disabled 8 Q29b (Reasonable adjustment): Has your employer made adequate adjustments to enable you to carry out your work? (For reporting year) % Yes %Yes: not needed %No 9 Does the board meet the requirement on Board membership (referred to in the Race Equality Standard) that ‘Boards are expected to be broadly representative of the staff and population they serve’? Board: % Local population %

28. NHS England Recommendations “Undertake wider engagement and a campaign of service action, with a view to implementing a mandated standalone WDES from April 2017, (giving the opportunity to learn lessons from the implementation of the Workforce Race Equality Standard WRES). This initiative would consider the broader policy context for employing disabled people detailed above, and would include liaison with the Department for Work and Pensions (DWP), and the Disability Confident campaign. Use the campaign and engagement exercise as an opportunity to consolidate and refine the draft metrics for a WDES; At a future point the EDC may wish to consider the accumulated impact of several separate equality standards upon the system and upon other agents of change, including EDS2”

29. Towards Inclusiveness: a disability as an asset approach to the WDES a social construct with organizational and individual components in which disability identity is seen as a positive both by the individual and the organization A shift from a negative stigmatizing position to a positive enabling perspective

30. Towards Inclusiveness: a disability as an asset approach to the WDES NHS Implementation Action Group + Reframing the discourse/social action campaign: not just supporting disabled staff to ‘catch up’ but recognising DAA: Co-production between staff and patients to help break down boundaries in planning and at frontline to understand and improve accessibility, reasonable adjustments, Access to Work, balanced disclosure create communicative space (trust, rapport) conducive to peer support and patient-/staff-driven initiatives experience/outcome measures-staff-patient interface..

31. Inclusive Leadership “Inclusive leadership is the practice of leadership that carefully includes the contributions of all stakeholders in the organization. Inclusion means being involved in decisions and resource allocation at all levels, being a valued contributor to the ultimate result. Inclusive leadership creates an organizational culture that consistently produces results that benefit all diverse stakeholder groups” (Ospina, 2011)

32. Characteristics of an Inclusive Organisational culture Acts as role model for diversity Challenges those not committed to diversity and inclusion Demonstrates an understanding of and commitment to diversity and inclusion policies Understands anti-discrimination legislation Promotes openness, transparency and inclusiveness in organisational decision- making

33. Some barriers to Inclusive Leadership Leader-member exchange (LMX) theory focuses on leadership as a process of interactions between leaders and staff members In group: Mutual trust; close collaborative communication; respect; reciprocal influence; more highly involved, and more communicative. Outgroup: Formalised, distant, non-reciprocal; more restricted to formal role and job requirements

34. Some LMX considerations Are substantially poorer WRES and WDES outcomes for BME and Disabled staff mediated through low LMX interactions between line manager and staff member?

35. Training/Service Development Implications A priority towards a focus on a high LMX/ DAA approach enhancing/enriching line manager supervision and appraisal training/service development?

36. NEXT STEPS We are keen to speak with disabled colleagues about their own views and experiences on these same issues. How can we ensure that we gather the thoughts of disabled colleagues on disability as an asset, the proposed WDES and the draft metrics? What actions can we take to ensure that disabled NHS staff will be directly involved and drive their own projects? What can equality partners do to spread information and support disabled staff groups on this agenda?

37. NEXT STEPS Please take this information back to your disabled staff networks and colleagues and let us know of any relevant projects or initiatives that we can link to. Please e-mail bernd.sass@disabilityrightsuk.org or contact: Bernd, 07906 521536bernd.sass@disabilityrightsuk.org Christine Rivers: Christine.Rivers@oxleas.nhs.ukChristine.Rivers@oxleas.nhs.uk Or contact Christine on: 01322 625700 ext 5817 Or Peter Ryan: p.ryan@mdx.ac.uk Or contact on: 0208 411 4908p.ryan@mdx.ac.uk A task and finish group (including DRUK and the research authors) will collate the information as part of a wider consultation on the proposed WDES metrics

38. Weblinks to the research http://eprints.mdx.ac.uk/18741/ http://www.nhsemployers.org/case-studies-and- resources/2015/05/different-voices-different-choices Disability Rights UK research: http://www.nhsemployers.org/your-workforce/plan/building-a-diverse- workforce/need-to-know/experience-of-disabled-staff-working-in-the-nhs