Despite considerable effort and countless initiatives, the Nuffield Trust has warned that inequality between NHS staff groups is persisting or even getting worse.
A new report, commissioned by NHS Employers, finds that crucial data is lacking, less high-profile groups are being overlooked, and the understanding of what actually works to improve diversity and equity is poor. Reported discrimination has risen across race, gender, disability status, and religion.
Nuffield Trust is warning that there is clear evidence that a lack of inclusion means worse care for patients. It also stands in the way of the health service’s ability to find and retain staff at a time when more capacity is desperately needed and targets require an additional 50,000 nurses.
Based on interviews with NHS trusts, a review of literature and data analysis, the paper points to a failure to recognise how many different specific groups can be subject to exclusion. While inequalities of race and gender are at least widely recognised, ethnic groups are too often lumped together and other disparities overlooked.
Data analysed for the report shows that: black staff are more than twice as likely to experience discrimination at work from a colleague as White staff; Muslim staff more than twice as likely to experience discrimination as staff of no religion; and those who prefer to self-describe their gender are twice as likely to experience discrimination as male or female staff.
Furthermore, ethnic minority staff are 27 per cent less likely than White staff to be ‘very senior managers’, the highest executive grades, whilst after nine years’ service, male nurses were over twice as likely to have progressed up two pay bands (41 per cent) as female nurses (20 per cent).
The report recommends that each NHS trust must ensure its diversity leads have access to continuing training, and that enough resources and senior posts are allocated to address the problem. The new Integrated Care Boards being set up to oversee the service should have special leads to focus on inclusion.
Dr William Palmer, Nuffield Trust Senior Policy Fellow, said: “On paper the NHS has recognised for years that disparities and discrimination among staff are morally unacceptable and disruptive to good quality care. Yet progress in actually reducing disparities has been painfully slow – and we even saw signs that bias may be getting worse.
“The good will and virtuous intentions we have seen are impressive, but they aren’t going to work alone. We need to move away from thinking about a couple of broad, high profile groups and recognise the specific issues that face individual religious and ethnic groups, and people with disabilities. The health service must be really honest about which solutions are really backed by evidence, and make sure this is widely known.”
Danny Mortimer, chief executive of NHS Employers, part of the NHS Confederation, said: “There is an absolute commitment from our members to finally address the inequities in our workplaces. This report highlights action that is being taken but rightly reminds us that far more urgency and impact is needed in every part of the NHS. To be clear, the link between staff and patient experience is irrefutable, and we have an obligation to improve the experience of all parts of the health service’s rich and talented workforce.”
