What are the challenges?

Pace of change and capacity

There was a strong recognition that it takes time to make an impact on race equality – with no quick fixes to build trust with ethnic minority colleagues. Similarly, there was an acknowledgement that it takes time to "establish a consistent culture across the organisation". Many leaders felt "capacity is the greatest barrier to being able to deliver against our action plans".

 

Prioritising race equality

Despite the positive response from some boards and governors who are receptive to change and may have taken part in broader EDI work, some trusts experience resistance to prioritising ethnic minority groups or EDI in their work. To combat this some leaders describe having to package work on race equality within a wider context: "if it was solely about race equality, the board may become disinterested – instead, it should be a mixed session, for example, include improving patient outcomes, systems etc." This is made worse by "learned behaviours or culture that hasn't in the past embraced racial equality."

One chair explains she has not seen much movement at the board level in terms of how they think about race. She describes conversations around the board table as “muted” and “correct” but outside the board table, members say they are tired of the agenda and the lack of impact.

   

Not being able to have meaningful conversations about race was cited by a number of trusts as a challenge. For one leader, conversations about race remained ‘nice’ conversations, with a focus on inclusion rather than race equality. Moving the conversation onto discrimination was difficult for some as was educating the board on the historical legacy of racism in the NHS and its impact on culture and decision making today. Some board members only engaged with the topic of race inequality intellectually and not emotionally, again, making it harder for leaders to prioritise race.

Organisations cannot survive when there are only few individuals fighting for change.

Chair    

Ethnic minority leaders are concerned about their white peers not being comfortable leading the race agenda. One respondent describes having 10 white chairs reach out to him privately for advice over the course of a year. They feel that their white colleagues are nervous about saying the wrong thing, offending ethnic minority colleagues or saying something that is taken out of context; they instead say nothing. Another ethnic minority chair described having very difficult conversations with board members around changes to recruitment as people expressed their concerns around “positive discrimination”. This led to a few, “what about me?” and “all lives matter” conversations with white NEDs in particular, causing on-going tension on the board.

Ethnic minority board members describe feeling pressured to lead on race because of their ethnicity. A key challenge for them is how to convey the importance of white colleagues being proactive in tackling race inequality and fostering a sense of shared responsibility and ownership. Ethnic minority leaders describe various tactics to counter this. One chair, although happy to be vocal on race equality, does not want the “shortcut” of being seen as the go to person of colour who is already well versed on the race agenda. Another chair signposts to other leaders on the topic rather than her.

A number of leaders highlighted the failure to translate talking about race equality into meaningful actions.

 

They did a good piece of work looking at racism within our trust and provided some hardhitting evidence of the reality, as well as a large number of recommendations. Sadly no progress yet in making these into an action plan with milestones and responsibilities.

NED    Combined acute and community trust

We do a lot of talking about race equality and anti-racism, but this has resulted in almost no concrete actions and we have not been able to show progress at all. I couldn’t answer the questions above because I don’t think we have made any real progress.

NED    Combined acute and community trust

Where intentions had been translated into action plans, other leaders describe the continued lack of measurable progress.

X explained that the board are frustrated as they are yet to see a big impact despite the work they have been trying to do. She gave the example of their WRES data not changing. Many of the board members have been exposed to equality training at different organisations and some within the NHS, but some believe, “they’ve heard it all before” and it is still not making a difference.

   

Knowing your community and attracting diverse talent

Another common theme was the lack of diversity in trusts’ local community or population relative to the rest of the country, as a reason for a lack diversity in their organisation. Leaders described not knowing enough about their local communities for example, not having a sufficiently granular understanding of local demographics or the challenges posed by transient populations. Similarly, there was a realisation that trusts did not know enough about their staff, particularly in terms of their protected characteristics.

The area we cover is large, with many smaller more rural and coastal communities which are not as ethnically diverse as a more compact urban area with ethnic minority patients and staff
quite isolated.

Chair    Combined mental health, learning disability and community trust

Foundation trusts describe having to work hard with their local communities and community leaders to encourage their interest in becoming members and governors in an organisation they know little about. Many members also expressed concerns about a lack of suitable and diverse applicants for senior staff roles, although some recognised the need for much more proactive engagement to develop a pipeline of ethnic minority talent rather than relying on a simple statement that 'applications from underrepresented groups are welcome'.

Members also questioned whether ICS boards are likely to be sufficiently diverse given the lack of diversity amongst existing system leaders.

X said it is important to define ‘talent’. He believes it is particularly important to challenge the use of the word “fit” which can lead to white staff recruiting in their own image and excluding ethnic minority talent. Instead, boards must define the skills needed for senior roles and think about where they can actively find people with these skills in local communities.

   

Middle management

Some respondents highlighted middle management and their resistance to change as being a barrier for their trust. However, engaging middle managers in change that was more "meaningful" was described as difficult. One NED suggested this could be due in part to entrenched "middle management customs and practices" and senior leaders not adequately managing this group. Chief executives felt leadership training and development should be made more of a priority and more widely available, for example to operational leaders.

Experience and impact of discrimination

There were concerns about the challenges experienced by ethnic minority leaders and staff, in particular the double burden of experiencing discrimination whilst having to continue to lead the race equality agenda, not to forget the emotional burden of having to draw on personal experiences of discrimination. One ethnic minority leader described the personal challenge of having to explain structural racism to white colleagues who would not have experienced inequality in the same way.

Leaders describe the challenges for ethnic minority staff having to work in services that did not acknowledge inherent racism in the NHS and processes that were a legacy of systemic racism. Some members described staff in their trusts who did not understand the barriers that ethnic minority staff experience despite overt racism among staff and patients. Within this context it was important for leaders that staff believed that 'appropriate action' would be taken against racism and that boards acknowledge the problem.

“There is a tendency for a subconscious belief that there is no problem with racism and having an external person hold up a mirror to the board is very useful indeed.”

NED    Acute trust

We are a trust where race issues are not as obvious as in others. So we have to be more alert to them being less observed. There is inadvertent racism and a lack of confidence in addressing this and calling out unacceptable behaviours. As a board we have had some development but could do more.

Chair