Equity in the NHS: staff are important too!

Policy and Management

Joan Pons Laplana, RGN - Proud Nurse, NHS Change Day Care Maker

Further Reading


Equality in the NHS?

The NHS is guided by seven principles, the first of which states that ‘the NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status’. The Nursing and Midwifery Council’s Code tells us that we must treat people as individuals and respect their dignity and that you must not discriminate in any way against those in your care. And of course, there is the 2004 Race Equality Action Plan [1]

The message cannot be clearer, but unfortunately, inequality and discrimination is happening on a daily basis in our NHS, and most of us are not aware of it. Statistics show that the number of managers from a black or minority ethnic (BME) background is decreasing.


We live in a society created by White British people for White British people; for BME people, it is clear that the majority of the services are design to serve a White British population. Simply obtaining products to suit our hair or skin, our dietary requirements, or our art and literature requires a specialised provider. Even the medical advice appears to be mainly for a population.

The BME population in the NHS

Ethnically, the NHS has a highly diverse workforce but, as demonstrated in the ‘Snowy White Peaks’ report, BME Staff at all levels, are still grossly under represented specially at senior levels [2]. For example, the proportion of London NHS Trust Board members from a BME background is 8%, an even lower number than the 9.6% reported in 2006. The BME population is largely excluded from senior management and trust board positions to a degree that is serious and systemic.

The gap between the diversity of the local population and both local and national NHS bodies is astonishing;

…there is a very significant gap between the composition of Trust Boards and national NHS bodies, and the rest of the workforce and the local population to whom services are provided. Research evidence suggests this may well adversely impact on the provision of services and denies the NHS the potential contribution a diverse leadership could make [2]E.

I have attended numerous BME meetings and conferences over recent months. What is evident is the feeling amongst BME staff is one of frustration Despite the Race Equality Action Plan, in 10 years, little has changed. Much noise is made, but no real difference is noted. However, that may be about to change…

Going forward

Equality is about fostering and promoting the right to be different, to be free from discrimination, and to have choice and dignity and to be valued as an individual, with a right to their own beliefs and values. Equality and Diversity is what makes our society richer.

A series of initiatives are coming together with a common theme: it’s time to break down the walls and fight for equality for everyone’s sake. A workforce race equality standard is to be implemented in April [3]. For the first time, NHS organisations will be required to demonstrate progress against a number of indicators of workforce equality, including a specific indicator to address the low levels of BME Board representation.

NHS England also has agreed to consult on incorporating the new standard and EDS2 [4] into the 2015/16 standard NHS contract for the first time. The regulators – the Care Quality Commission and Monitor – will also consider using the standard to help assess whether  or not organisations are ‘well-led’.

As Simon Stevens says:

“We want an NHS ‘of the people, by the people, for the people’. That’s because care is far more likely to meet the needs of all the patients we’re here to serve when NHS leadership is drawn from diverse communities across the country, and when all our frontline staff are themselves free from discrimination.”

As a nurse I also see the Chief Nursing Officer (CNO) for England, Jane Cummings tackling the issue and is committed to putting Equality and Diversity at the heart of nursing practice.

But while these things are happening at the top we have a responsibility to start to act at the frontline. As a BME nurse, I would like to encourage everybody to break the walls that we have built around us and come out of our comfort zone. We need to believe in ourselves and our potential. We are no different from our White British colleagues. It is time to take responsibility and ask yourself what you can do to create a better NHS. Don’t wait for the things to change, initiate it and do the first step. It’s the only way to move from where we are to where we want to be. A little change can make a big difference. You are not alone. There are plenty of things you can do and many initiatives are popping up across the country. For example:

  • NHS Employers has created a vibrant network of champions who are committed to taking actions, however small, to create a personal, fair and diverse NHS  http://www.nhsemployers.org/campaigns/pfd-campaign
  • A new BME Network initiative launched in 2010, chaired by professor Vivienne Lyfar-Cisse, will challenge and champion race equality across the NHS, to provide  leadership,  innovative initiatives and solutions, and be a critical friend to all NHS organisations http://www.nhsbmenetwork.org.uk
  • The Royal College of Nursing has created the Diversity Champions initiative to ensure the development of an inclusive workplace where we all feel valued, appreciated and significant http://www.rcn.org.uk/support/diversity/diversity_champions
  • The CNO's BME Advisory Group is also a very good place to keep updated about what´s happening in the NHS regarding Equality and Diversity http://www.6cs.england.nhs.uk/pg/groups/93869/ 

I also I want to extend the invitation to all the White British Staff. Only when we start to get together and more White British people walk in our shoes and listen about our situation, the quicker we can improve. Personally, I want to see more White British nurses and managers attending BME meetings and conferences.


Organisations that embrace diversity will reap the benefits of using the resources available from a wider pool of talent; for example, they can:

  • improve productivity
  • raise their profile in the community
  • deliver better patient centered care because they will be able to understand the population they care for better
  • attract, recruit and retain a wider talent pool

Equality and Diversity is everyone’s business. As the Constitution says, the NHS belongs to all us, and is up to all of us to make a more fair and diverse NHS with equal opportunities for everybody, staff and patients.

Only by Improving equality and reducing discrimination and disadvantage for all at work we will be able continue the have the best health care system.

As Maya Angelou says:

You may write me down in history
With your bitter, twisted lies,
You may tread me in the very dirt
But still, like dust, I'll rise.

Does my sassiness upset you?
Why are you beset with gloom?
'Cause I walk like I've got oil wells
Pumping in my living room.

Just like moons and like suns,
With the certainty of tides,
Just like hopes springing high,
Still I'll rise.

Did you want to see me broken?
Bowed head and lowered eyes?
Shoulders falling down like teardrops.
Weakened by my soulful cries.

Does my haughtiness offend you?
Don't you take it awful hard
'Cause I laugh like I've got gold mines
Diggin' in my own back yard.

You may shoot me with your words,
You may cut me with your eyes,
You may kill me with your hatefulness,
But still, like air, I'll rise.

Does my sexiness upset you?
Does it come as a surprise
That I dance like I've got diamonds
At the meeting of my thighs?

Out of the huts of history's shame
I rise
Up from a past that's rooted in pain
I rise
I'm a black ocean, leaping and wide,
Welling and swelling I bear in the tide.
Leaving behind nights of terror and fear
I rise
Into a daybreak that's wondrously clear
I rise
Bringing the gifts that my ancestors gave,
I am the dream and the hope of the slave.
I rise
I rise
I rise.

Let´s all rise together.