THE NHS’ commitment to diversity and inclusion has been called into question, after a new report revealed that fewer people from black and minority ethnic backgrounds and women are being appointments in key roles running NHS trusts.
The findings were discovered in a report by the NHS Confederation, which represents 85% of local health service bodies in England. In the report, it reveals that the proportion of chairs and non-executive directors of NHS trusts in England who are from an ethnic minority has almost halved from 15% in 2010 to just 8%.
The proportion of women in those posts has also fallen from 47% in 2002 to only 38%, despite a the increase of initiatives aiming to improve women and BME representation in senior NHS roles.
“The progress and gains made in the early 2000s towards a more diverse board leadership in NHS trusts has gone into reverse or made no progress,” the report said.
“As a community of leaders, chairs and non-executive directors are often not representative of the communities they serve and the staff they govern.”
This declining number signals a setback for NHS England chief executive, Simon Stevens who made improving BME representation a key priority during his five years in charge.
As a result, the report shows their failure to follow through on this promise to improve female and BME representation. “Equality, diversity and inclusion is an area that the NHS needs to make significant progress in to reflect the spirit of the equality and diversity legislation and the NHS’s stated ambition to create a more diverse leadership,” says the report.
The report blames the widening gaps in female and BME representation due to two key factors.
The first was the abolition of the NHS Appointments Commission in 2012. The Commission oversaw appointments to a range of NHS public bodies and brought a degree of rigour and consistency to the recruitment of senior leaders. It was never replaced although NHS Improvement does have some limited influence over some chair appointments to NHS foundation trusts.
The second was the creation of foundation trusts in the mid-2000s. From the outset, foundation trusts were conceived as independent public benefit organisations, which meant any appointments to their boards would not be considered public appointments.
Although overseen by elected Boards of Governors at local level, non-executive appointments made by foundation trusts are therefore not subject to further scrutiny and oversight.
Joan Saddler, Director of Partnerships and Equality at the NHS Confederation and co-chair of the NHS Equality and Diversity Council, said: “This report must be a wake-up call for a health service which is heading in the wrong direction and becoming less diverse at board level. That is not right for patients and staff working in NHS organisations.
“We support the autonomy of foundation trusts but we must find a way of developing inclusive top teams that provide example and leadership, and set expectations throughout their organisations.
“Chairs and non-executives heading NHS organisations must be accountable to and representative of the communities they serve and the staff for whom they are responsible. It is about fairness but also simply about good governance and improving the quality of patient care and engagement – and it needs to start at the top.
Danielle Oum, chair of Walsall Healthcare NHS Trust and co-chair of the NHS Confederation’s BME Leadership Network, commented: “Diversity on boards is important for diversity of thought and the avoidance of group think. It’s particularly key for the NHS due to the makeup of its workforce and the population it serves.
“History has shown that when there is structural change in the NHS, diversity of leadership reduces – we need to avoid that legacy in the development of integrated care organisations and associated reconfigurations.”
Ifti Majid, chief executive of Derbyshire Healthcare NHS Foundation Trust and co-chair of the BME Leadership Network, added: “At the heart of the role of boards is improving health outcomes for local people and we know boards that are representative of local communities are more able to achieve that.
“Having the confidence of local people is essential to this task and if local people don’t recognise their views, beliefs and cultures around our board tables that confidence will not form.
“The time for passively accepting inequality has long passed.”