The NHS is moving backwards in terms of board diversity | Joan Saddler

Joan Saddler

Given the drive and commitment to create a more diverse and inclusive leadership at the top of the NHS, it is a startling fact that fewer black and minority ethnic people and women now occupy chair and non-executive positions, writes Joan Saddler, the NHS Confederation’s director of partnerships and equality in a piece originally published in the HSJ. 
These leaders are a critical component of the boards that run NHS organisations in England. That they have become less diverse over the last 15 years represents a worrying development that needs addressing urgently.
There is strong evidence for the positive impact that diversity and equality in leadership has on organisational performance and culture. This is the case across the private, not-for-profit and public sectors.
Research published by the NHS Confederation in the last week outlines the scale of the challenge the NHS faces in turning this round.

Diversity in leadership is important for the future of the NHS, particularly in light of the need to implement the new NHS long-term plan which promotes greater integration between staff and expresses the need for transformational change across health services.
The percentage of chairs and non-executives of NHS trusts from a BME background has nearly halved in the last decade – from 15 per cent in April 2010 to 8 per cent today.
The percentage of women in chair and non-executive roles has fallen from 47 per cent in 2002 to 38 per cent now. At the same time there has been no increase in the proportion of non-executive leaders with a disability – this has remained static, between 5 and 6 per cent.
The problem with decreasing diversity on boards is particularly obvious in the NHS because it has a large proportion of female employees and BME staff who play key roles.
Although the reasons are unclear, we think there are two factors that may have had an impact on board diversity.
The first is the abolition of the NHS Appointments Commission, which oversaw appointments to a range of NHS public bodies until 2012 when it was abolished.
The Appointments Commission brought a necessary rigour of independence to the recruitment process, as well as ensuring that chairs and non-executives had annual performance appraisals, received proper training and were given full support for their board work.
It was never replaced like for like and, by default, NHS Improvement is now the Appointments Commission for NHS trusts. Its reach has been extended to include influencing chair appointments to NHS foundation trusts that have licence breaches.
The second factor was the decision in 2006 to rule that any appointments to foundation trust boards would no longer be considered public appointments.
Although overseen by elected boards of governors at local level, non-executive appointments made by foundation trusts are not subject to further scrutiny and oversight.
We are calling for a review of the appointments process to help address this diversity deficit. This is the first report from our new BME Leadership Network and we are determined to play our part in supporting NHS leaders to put this right.
We make a number of recommendations, including that NHS England/Improvement should appoint a lead chair to work with the NHS Confederation to make recommendations to ministers for addressing the diversity deficit in NHS boards.
We also want to see a review of search firms to ensure they are incentivised and can provide diverse shortlists for NHS organisations.
The evidence for this much-needed change is clear: diversity and equality in leadership has a positive impact on organisational performance and culture. This is the case across the private, not-for-profit and public sectors.
Boards across the UK and those with an international reach are seeking to create better diversity and promote women into board roles.
A small number of companies actively seek to recruit skilled BME board members from a ‘go to’ database of names with the correct characteristics and background who are judged to be ready and able to perform such roles.
It is a cause of concern that the NHS is going backwards when other industries are making such progress. This will not only hamper efforts to achieve the ambitions set out in the long-term plan, but it will also stop NHS organisations from meeting the needs of all their local communities.
Equality, diversity and inclusion leadership in the NHS is about having best practice in the governance of NHS organisations, better engagement with the staff which will lead to better and significant improvements in the standards of care to patients delivered within its institutions.
The time for passively accepting inequality has long passed – as boards and senior leaders we must actively seek difference and be creative about how we look to be inclusive as without this we will make decisions that are not well informed.
If NHS organisations are to create a sustainable pipeline of diverse leaders serving all communities then we must seek ways to accelerate this transition at the top.
We, therefore, hope this report serves as a wake-up call. Through our new BME Leadership Network, we will support front-line and national leaders in delivering progress in this vital area.
Joan Saddler OBE is director of partnerships and equality at the NHS Confederation and co-chair of the NHS Equality and Diversity Council. She will be speaking at Confed19 on 19-20 June in Manchester. This piece was originally published in the HSJ. Read the report Chairs and chief executives in the NHS: the need for diverse leadership.

Joan's addition - 12/6/2019:

The recent coverage sparked by the NHS Confederation publication about the paucity of diversity amongst NHS non-executives tells us three things:

  • Evidence tells us we are not doing as well as we should to ensure diversity in non-executive appointments. We need to fast track some of the progress beginning to be made through programmes such as the 50/50 by 20/20 women board representation programme and the Workforce Race Equality standard (WRES) where BME non-executives in London have increased from 19 in 2015 to over 50 in 2019. Such programmes require robust processes and practical leadership and organisational commitment to make change happen.
  • Responsibility for non-executive appointments are largely made at a local level. We need to ensure that support is available for leaders to do the right things in appointing diverse non-executive leaders particularly as Trust Chairs.
  • Never before has a national NHS strategy set the stage for ensuring BME non-executives and executives are appointed. The NHS Plan through the Model Employer Strategy is an important  guide in this respect. However, the process for non-executive appointments needs to be strengthened and it needs to be independent. Again the evidence tells us that success follows such an approach.

Future system leadership requires understanding and experience of integration in its broadest sense. Therefore the time for independent appointments from a diverse leadership pool is now and action must follow commitment, appointing diverse leaders working across sectors and within the various national bodies. The NHS Plan rightly promotes local leadership and the appointment of diverse non-executives is a significant area where local leaders can make a difference. 


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