In July 2014 the NHS introduced a Workforce Race Equality Standard, now affectionately known as WRES, and to my mind, this is a great example of using knowledge of an inequality to actually do something to remove that inequality. And not just doing a little something but requiring the whole NHS to measure how unequal their organisation is and to take steps to reduce that inequality year on year.
Some BME (Black and Minority Ethnic) staff networks have been talking about some of these issues for years – the glass ceiling round about bands 5 or 6 that most BME staff don’t get through into more senior jobs and that if you’re BME you are often less likely to find out about those chances for secondment that can lead to promotion, for example. Yet staff networks were generally seen to be about providing mutual support for individual BME staff rather than helping an organisation to identify a systemic issue and then do something about it.
Some of us working in equality and diversity in the NHS were pleased to discover robust statistical evidence of this inequality in the NHS staff survey reports, freely available on the internet and including tables that showed differences in the reported experiences of BME staff and White staff and that these differences persisted across organisations and from one year to the next. We dutifully included this data in our EDS (Equality Delivery System) reports but generally struggled to get colleagues and senior management teams to show an interest, let alone take action.
Now WRES lists the indicators where nationally the inequalities are starkest and requires all NHS provider organisations to measure their progress on workforce race equality and to publish an action plan showing how they are going to tackle the most significant inequalities in their organisation. Clinical Commissioning Groups should be monitoring how well NHS organisations are doing this and the CQC (Care Quality Commission) is picking it up in their inspections. Nationally WRES performance is being monitored and benchmarked.
What has made the difference? I think the following have all contributed:
the dogged determination of some individual people like Roger Kline and Yvonne Coghill
bringing together different types of knowledge
- research evidence like the Snowy White Peaks of the NHS which showed how few BME people there are employed in senior positions in the NHS and NHS Staff Management and Health Service Quality which showed that patients (of all ethnicities) have a better experience in organisations where race equality is good
- individual BME members of staff sharing their experiences of working in the NHS
- statistical data gathered in the NHS staff survey
- pulling together that evidence into a compelling narrative about why action to improve workforce race equality in the NHS is urgently needed. Making it clear that better race equality will ensure we have the best possible staff working in the NHS and will improve patient care for everyone
using WRES data for problem sensing rather than comfort seeking purposes as Mary Dixon Woods describes in her research about NHS culture. Her description of how NHS managers and boards often use data for assurance purposes rather than to identify issues and opportunities for improvement reminded me of how many NHS organisations have approached the publication of data to meet the requirements of equalities legislation. A great example of complying with the letter but not the spirit of the law.
- bringing together different sorts of knowledge,
- framing that knowledge to show why it is important to act on it
- using knowledge to identify issues that need addressing rather than for reassurance
These are key principles to effectively moving knowledge about ethnicity and health to action.