Race equality in NHS recruitment: good intentions are not enough

I was asked recently by a trust chief executive who is serious about tackling race discrimination, 'why are we struggling to make progress when we have so many things going on to improve recruitment and career progression?'

It was a good question. Equality and fairness are core NHS values in both patient care and staff treatment, and most NHS trusts have extensive action plans to tackle race discrimination. Yet the data remains stubborn.

The latest NHS Workforce Race Equality Standard (WRES) data shows a white shortlisted candidate is 1.5 times more likely to be appointed than an ethnic minority candidate – no improvement since 2018. The cumulative impact of that difference means, astonishingly, it is 20.5 times more likely that a white band 5 nurse would become a band 9 senior nurse compared to an ethnic minority band 5 nurse.

Why?

For any other proposal put forward to address such a challenge NHS boards ask: 'What confidence do you have that this will bring the change you seek?' But few boards do this for equality, diversity and inclusion (EDI) or recruitment and career progression. Reasons for this include the reluctance to have honest conversations (in feedback or appraisals) about race or with ethnic minority staff, alongside patterns of denial and avoidance. But the crucial reason is that the methods proposed to improve fairness in recruitment have been fatally flawed. They have relied on the traditional combination of policies, procedures and training, but research (summarised in No More Tick Boxes) clearly shows that, in isolation, this approach will fail. NHS organisations are increasingly recognising a different approach is needed and that while diversity and unconscious bias training may assist understanding, good intentions are not enough.

There are three preconditions to shift the dial:

1. Debias processes, not just individuals. Bias affects every stage in the career cycle from creating a job to onboarding a successful applicant. Research suggests how we can debias each stage of recruitment - for example, we should monitor outcomes of appraisals by protected characteristic, being alert to disproportionate representation of some groups with lower outcomes. We should ensure appointment processes do not rely solely on interviews but on at least one other data point such as situational judgement tests, values-based interviews, or work samples. In interviews themselves, we must insist on well-structured processes with each competency having model answers for, 'outstanding, good, adequate and poor' responses with a scoring system that is strictly adhered to.
   
   
2. Insert accountability. People who are scrutinised change their behaviour, especially if there are consequences. We must stop the 'tap on the shoulder' path of gaining access to the 'stretch opportunities' which crucially impact career progression. By monitoring access, we must challenge disproportionate access for already over-represented staff groups, and ensure equity in access, such as via talent pools. We should expect panel chairs to be able to explain their appointment decision and set out what will be done to support staff good enough to be shortlisted but not appointed to do better next time. Such steps already happen in some trusts. They should happen universally.
   
   
3. Inclusive leaders should be role models. Research shows inclusive leaders who model the behaviours they expect of others, who use data dashboards and other means to identify good and poor outcomes on EDI, and who set goals and challenge (but then support) those who don't achieve them, are crucial to ensuring accountability and debiasing.

To enable these dial shifts, leaders need to set expectations for behaviour and delivery against commitments, use a critical lens to improve outcomes, and focus on equipping managers with the right tools – as outlined in the Leadership for a collaborative and inclusive future review. It requires a national repository of good practice as well as national bodies to model the behaviours expected of everyone else. It means being clear that without inclusive teams' sustainable improvement in diversity of representation, a representative workforce at all levels will continue to be an uphill challenge.

But the prize is considerable. Diverse and inclusive teams are more creative and innovative, have better staff engagement and retention, have improved communication and collaboration, and above all else, provide safer and better care for patients.

To those who say, why should we focus on racial equality? I say, because we cannot afford not to.

Roger Kline    Research fellow, Middlesex University

One quarter of NHS staff are of ethnic minority heritage. Discrimination disrupts team working, undermines patient safety, accelerates turnover and reduces productivity. How can we expect our staff to show respect and compassion to patients if they do not experience it themselves at work?

NHS trust boards must pay closer attention to what their data and lived experience tell them. They should insist that staff proposing strategies to improve equitable recruitment and career progression can explain why they think their proposals have a reasonable likelihood of working. They should expect all boards' reports to consider the equality implications of proposals. And above all, be problem sensing, not comfort seeking when it comes to evidence of race discrimination.

NHS Providers' Race equality programme helps to embed race equality as a core part of the boards business by encouraging hearts and minds change, building their confidence and capability to act and embedding accountability.

Roger Kline was commissioned by NHS Providers to advise on and support their work on inclusive recruitment and talent management.

This blog was first published by HSJ.