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    The “snowy white peaks” of the NHS

    The is increasingly robust evidence that how healthcare staff are treated and diversity in healthcare leadership makes a decisive difference to healthcare and to the well being of healthcare staff.

    Roger Kline blogs on his new report into diversity in the National Health Service. Roger is a Research Fellow at Middlesex University Business School.

    There is increasingly robust evidence that how healthcare staff are treated and diversity in healthcare leadership makes a decisive difference to healthcare and to the well being of healthcare staff.

    Yet new research has found that the absence of Black and Minority Ethnic (BME) NHS staff from the leadership of the NHS is serious, systemic and has shown no sign of improving in recent years.

    "The "snowy white peaks" of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England" finds that the Black and Minority Ethnic population is largely excluded from senior positions both as NHS managers and as NHS Trust Board members. You can find the report here.

    This pattern extends to all national NHS bodies, and appears to be particularly serious in London. I found no evidence that NHS Boards and senior management have become more diverse in recent years as Ministers have suggested. In London, for example, despite 45% of the population and 41% of the NHS workforce being from BME backgrounds:

    * The proportion of London NHS Trust Board members from a BME background is 8%, an even lower number than the 9.6% reported in 2006 

    * The proportion of chief executives and chairs from a BME background amongst London's Trusts has decreased such that there is currently one BME chair and (as of this month) no BME chief executive

    * Two fifths of London's 40 NHS Trust Boards had no BME members (executive or non executive) on them at all, whilst over half of London's Trust Boards either had no BME executive members or no BME non-executive members.

    * There has been no significant change in the proportion of non executive BME Trust Board appointments in recent years, continuing the pattern of under-representation compared to both the workforce and the local population.

    * The proportion of senior and very senior managers who are BME has not increased since 2008, when comparable grading data was last available, and has fallen slightly in the last three years. The likelihood of white staff in London being senior or very senior managers is three times higher than it is for black and minority ethnic staff.

    * The ethnicity and gender diversity of the leadership of national English NHS bodies is poor, with BME executives being entirely absent, and women being disproportionately absent, from the Boards of all the key national bodies - NHS England, Monitor, the NHS Trust Development Authority, Heath Education England, and the Professional Standards Authority.

    The report considers the extent of the gap between the diversity within the workforce and the local population, and that visible among Trust leaderships and senior management. That gap is then considered in the light of growing evidence about the impact of staff and Board diversity on the effectiveness of healthcare provision and the patient experience.

    The data this report analyses demonstrates that there remains a very significant gap between the composition of Trust Boards and national NHS bodies, and the rest of the workforce and the local population to whom services are provided. Research evidence suggests this may well adversely impact on the provision of services and denies the NHS the potential contribution a diverse leadership could make. It is hoped this report will help to trigger urgent discussion and action to remedy the waste of talent and adverse impact on healthcare this report suggests is taking place.


    This report was published on 10 April 2014.

    Roger Kline is also author of Discrimination by Appointment (2013) and joint author with Michael Preston-Shoot of Professional Accountability in Social Care and Health:
    Challenging unacceptable practice and its management. (Sage 2012).

    Roger Kline tweets at @rogerkline.

    Comments (2)

    • Rae 26.08.2015
      This research rings true, and is my experience within my almost 30 years (in 2017) of working in the NHS
    • Martin Hodgson 13.01.2015
      I don't know what the situation is like in senior management and boards here in Sheffield, but I do know that a similar picture would be found at middle management. I think there is subconscious, unexpressed but institutionalised discrimination against would be middle management aspirants among BMEs

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