Transcript Discrimination by appointment: we have a problem we need

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
• “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
• 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• Unpublished data from local government on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)
Methodology
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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
• 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
White BME
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•
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•
•
Applied
Shortlisted
Appointed
Ratio application/appointed
Ratio shortlisting/appointed
Ratio application/appointed
Ratio shortlisting/appointed
68%
78%
85%
1.25
1.09
2.98
1.76
31%
21%
13%
0.42
0.62
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
• In 2010 Archibong and colleagues found that only onefifth 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
• 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 8a9 but 5% of BME staff
• “Snowy” peaks of NHS remain white
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
• 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….
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”
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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?
• 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 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?
• 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?
• 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?
Thank you
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