Discrimination by appointment we have a problem we need to talk about
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Discrimination by appointment: we have a problem we need to talk about. Roger Kline. Research fellow, Middlesex University. Associate, Public World. Context: services and race.

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Discrimination by appointment we have a problem we need to talk about

Discrimination by appointment: we have a problem we need to talk about

Roger Kline.

Research fellow, Middlesex University. Associate, Public World.

Context services and race
Context: services and race

  • “According to data released by the hospital about two percent of all mothers treated at the maternity unit in 2008 came from ethnic minorities. This compared to 83 per cent of "serious untoward" cases at the unit involving ethnic minorities.”

    Daily Telegraph 12 Sep 2011

  • “A major peer review of services for patients with sickle cell disease and thalassaemia in England found just a fifth had adequate numbers of staff with the right skills ……... patients regularly lost out on beds on specialist wards to patients with white blood cell disorders such as leukaemia.”

    HSJ. 3 September, 2013

What prompted this analysis
What prompted this analysis

  • NHS England recruitment: HR response

  • Anecdotal reports of impact of cuts and “transition” on BME staff esp. senior staff

  • London Grade 8a-9 data

  • Any impact from Equality Act and EDS – fears race slipping down agenda?

  • No national data since 2008

  • Unpublished data from local government on recruitment and discipline (2012)


  • Literature search

  • Web search of 60 Trusts in March 2013

  • Data analysis

  • Reflect on Trust and NHS England learning

  • Present data in context without identifying specific remedies or causes

  • The initial goal was to help put race back on NHS workforce agenda

What we found
What we found

  • Even after shortlisting, white applicants are 1.78 times more likely to be appointed.

  • For senior manager posts in NHS England, white applicants were between four and six times more likely to be appointed than black applicants.

  • Half Trusts did not publish recent usable data

  • No Trust compared BME/white likelihood of appointment

  • Trusts reports either

    • Silent

    • Acknowledged issue but not scale

    • Pointed to increased applicants

    • Compared staff %age with local population

What we found typically
What we found: typically

White BME

  • Applied 68% 31%

  • Shortlisted 78% 21%

  • Appointed 85% 13%

  • Ratio application/appointed 1.25 0.42

  • Ratio shortlisting/appointed 1.09 0.62

  • Ratio application/appointed 2.98

  • Ratio shortlisting/appointed 1.76

The post francis landscape lessons from patient safety
The post Francis landscape:lessons from patient safety?

  • Collect, analyse, publish and learn from data

  • Listen to patients and staff

  • “Just” culture – not blame

  • Practical steps

  • Openness and transparency

  • Monitor and start again

  • Leadership is key

Data a real problem
Data: a real problem

  • In 2010 Archibong and colleagues found that only one-fifth of all NHS Trusts published recent disciplinary data that could be included in their study

  • In 2012 the Equality and Human Rights Commission (EHRC) survey of public authorities’ implementation of the duty to publish information reported approximately half of English public authorities were fulfilling the Equality Duty requirement to publish equality information on their staff and service users.

  • Recent EHRC on PSED in NHS

  • Equality Act may have reduced race monitoring

Our results in line with other nhs recruitment data
Our results in line with other NHS recruitment data

  • HSJ survey 2008 had slightly better likelihood of BME staff being appointed then our survey

  • Black nurses take 50% longer to be promoted than white nurses whilst BME nurse graduates find it much harder to find their first job.

  • In London 14% of white staff are on bands 8a-9 but 5% of BME staff

  • “Snowy” peaks of NHS remain white

Nhs progress on psed objectives
NHS progress on PSED objectives?

  • One or more objectives were linked to the aims of the general duty

  • One or more objectives were clear about the quantity of improvement sought

  • One or more objectives were clear about the timeframe for improvement

  • One or more objectives were clear about who was responsible for delivery

  • 30.6%

  • 37.1%

  • 59.6%

  • 54.7%

    EHRC Sept-Dec 2012

Triangulate other data
Triangulate other data

  • In 2012 NHS staff survey, 8% staff report they had experienced discrimination from work colleagues in last twelve months, of whom half (4%) reported race discrimination

  • How many BME staff in current senior leadership positions (or potential future leaders)across NHS in providers and national bodies?

  • What do BME staff say if in safe environment?

Discipline and other indicators too
Discipline and other indicators too….

The Involvement of Black and Minority Ethnic Staff in NHS Disciplinary Proceedings (2010):

  • Overall, BME staff were almost twice as likely to be disciplined by comparison with their white counterparts.

  • “Union representation was characterised by some BME staff as not sufficiently sensitive to their needs”

Other indicators:

  • Pay?

  • Grading?

  • Nurse consultants?

  • Access to CPD?

  • Impact of transition from PCTs/SHAs etc?

  • What will impact of discretionary pay be?

Why is this bad for patients
Why is this bad for patients?

  • Are the best staff being appointed?

  • The cost of lowered morale for staff – commitment, retiring early, turnover?

  • The impact on patient experience (Dawson 2007)?

There have been plenty of national initiatives but
There have been plenty of national initiatives, but…..

  • There is no substitute for leadership on the ground

  • It is not important in most Trusts – why?

  • Not a single trust analysed data how we did – why?

  • Are we clear what obstacles to progress are?

  • Do we not need to do much better?

    • If so, how?

What next the nhs
What next: the NHS?

  • Learn from Francis and patient safety

    • Data not denial – must know what to change

    • Drill down but lead across

    • Engage with staff – especially listen to what BME staff say

    • Open and transparent

    • Change culture to “just” culture – learn not blame – address “unconscious” bias

  • Must not rely on grievances and ETs but be proactive

  • Leadership crucial

  • Essential best practice on race identified, analysed and shared but is 20/80 good enough?

  • Does EDS yet ensure BME staff issues addressed?

    • Why not an element of CEO performance review?

    • Open transparent monitoring of timely measurable goals

    • Celebrate success but acknowledge shortcomings and address with specific timely goals

  • What next the forum
    What next: the forum?

    • How can the forum work together and build on these findings?

    • Further research involving the forum members?

    • How can the forum work together to inform and mobilise the system?

    Discrimination by appointment we have a problem we need to talk about

    Thank you