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

2. 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

3. 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…!

4. 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

5. 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]

6. 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.

7. 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

8. 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

9. 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

10. 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.

11. 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.

12. 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)

13. 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)

14. 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)

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

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

17. 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.

18. 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)

19. 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

20. Resources and further information
WEB: