I have been interested in improving the culture and behaviours around the area of workforce race equality for some time, so I welcomed receiving a letter from our Chief Nursing Officer for England this month. She wrote to all nurse directors about the issue, highlighting that the Workforce Race Equality Standard (WRES) evidence is showing that, if you are from a black and minority ethnic (BME) background, you are more likely to go through the formal disciplinary process compared with white colleagues in the same organisation. As nurse leaders, we are called to action, to work with our human resource colleagues and to lead the way for nursing and midwifery staff on this important issue—and, in so doing, help ensure a fairer NHS for all.
The letter was accompanied by a guide to support local practices in promoting workforce race equality, focused on closing the ethnicity gap in rates of disciplinary action across the NHS workforce, under the strapline ‘a fair experience for all’.
The publication of the Interim NHS People Plan (2019) has highlighted results from the 2018 national NHS staff survey, showing that BME staff report some of the poorest workplace experiences. It states that it is not enough for the NHS merely to continue to champion the idea of inclusion and diversity. It encourages us to recognise our shortcomings and listen to the experiences of those who face exclusion and marginalisation to promote an understanding of how to advance equality and diversity. It advocates the development of leaders to create and sustain cultures of compassion and inclusion.
The ‘air experience for all’ guide notes that, since its introduction in 2015, the WRES has required NHS trusts and clinical commissioning groups to assess themselves annually against nine indicators of workforce equality, including one that looks at the relative likelihood of BME staff entering the formal disciplinary process compared with their white counterparts in the same organisation. Although it reports that, since 2016, there has been improvement in this area, more needs to be done to overcome the scale of the challenge.
NHS Improvement (2019) is supporting the need for a national ambition, and the national WRES team is offering to support individual organisations to:
What I like about the ‘fair experience for all’ guide are the shared practical examples of good practice. The guide details four models to consider for improvement, with pros and cons for each approach:
From a nursing perspective, one programme that I have experience of is the Royal College of Nursing (RCN) cultural ambassadors (CA) initiative. This is designed to recruit staff from BME backgrounds at Band 6 and above, placing them alongside investigating managers and disciplinary and grievance panels involving BME staff, to identify and challenge potential bias and discrimination. The programme works as a partnership between the RCN and NHS trusts, with the college offering training and ongoing support under a reflective model.
Traditionally, I am used to trust boards having oversight of disciplinary issues relating to medical staff and welcome that, in 2019, NHS England (2019) and NHS Improvement made recommendations that all NHS boards should consider how they oversee investigations and disciplinary procedures for all staff. They make seven key recommendations, which are:
NHS England makes clear that a compassionate and learning culture is fundamental to enabling the required improvements. It states that several components need to be in place, including a clear organisational vision and leaders' ability to listen to those whom they lead in the right environment, which includes conditions for quality improvement within team structures.
I am pleased the guide has been shared—it will enable us to make improvements and I shall be discussing the suggested models with colleagues.