A recent report by the NHS Confederation suggests that diversity and inclusion in the NHS is going backwards, despite initiatives aimed at improving the representation of women and people from BAME backgrounds in key roles running NHS trusts. The proportion of chairs and non-executive directors who are from a BAME background has almost halved since 2010, from 15% to just 8%. The number of women in these roles has also decreased, from 47% in 2002 to 38%. As the report states, ‘the progress and gains made in the early 2000s towards more diverse board leadership in NHS trusts has gone into reverse,’ meaning that NHS leaders are currently ‘not representative of the communities they serve and the staff they govern’.
The NHS depends on its female and BAME staff. 77% of NHS employees are women and 18% are from BAME backgrounds, making it the largest employer of BAME staff in the UK. However, significant barriers are preventing people from making it to top positions. For example, NHS England has reported that BAME staff face bullying, harassment and discrimination, are less likely to be shortlisted or have access to career development opportunities and are disproportionately involved in disciplinary procedures and capability reviews.
The NHS has also been criticised for its significant gender and ethnicity pay gaps. Male doctors earn an average of 17% more than their female colleagues, an increase of 2% since 2018. This is because the highest paid consultants, such as surgeons and urologists, are disproportionately men. There are currently 32,000 male consultants and 18,000 female consultants and though this gap is narrowing, barriers such as inflexible working hours and negative attitudes towards part time work continue to discourage many women from completing their consultancy training. Sally Davies, the former president of the Medical Women’s Federation stated, ‘we’ve always thought as more women come through the pipeline things would level out, but it isn’t happening as fast as you might expect’.
The NHS is also struggling with a significant ethnicity pay gap. An analysis of 750,000 staff salaries found that black doctors are paid an average of £10,000 less per year than their white counterparts and black nurses an average of £2,700 less. Black men working in the NHS across all roles earn an average of £5,796 less than white men and black women £1,980 less than white women. Dr Chaand Nagpaul, the chair of the British Medical Association, said ‘it cannot be right that in 21st-century Britain there are such wide gaps in pay between white and BAME doctors when, irrespective of their background, they hold positions to deliver the same care to patients’.
The underrepresentation of women and BAME employees in NHS leadership positions has significant implications for the quality of healthcare services in the UK. Diverse teams are continually shown to be more productive and innovative and contribute to better products and services. Diverse leaders also provide essential role models for the future generation of aspiring healthcare professionals. Female and BAME NHS workers are currently underused talent, who could and should be playing a pivotal role in leading the health service and responding to some of the significant challenges it currently faces. Furthermore, as the largest employer in the UK, it is vital that the NHS is a leader in workplace diversity and inclusion. As Joan Saddler, Co-Chair of the NHS Equality and Diversity Council argues, recent reports on diversity and inclusion in the NHS ‘must be a wake-up call for a health service which is heading in the wrong direction’ and should inspire NHS leaders to prioritise diversity and inclusion and investigate the barriers preventing female and BAME staff from getting to the top.
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