- Wednesday, October 02, 2024
REVEALED: The extent of white-only senior teams who run England’s hospitals
By: BARNIE CHOUDHURY
MORE THAN half the NHS trusts in England do not have a single south Asian executive director, an investigation by Eastern Eye can reveal.
Our analysis of 217 trust boards also revealed that more than four in 10 (42 per cent) do not have a single senior leader of colour.
Executive directors are responsible for the day-to-day running of hospitals, ambulance trusts or integrated care boards, which plan a community’s health needs.
Sources have told us of the shame and shock they feel about the lack of ethnic representation.
“I find this really concerning, the NHS owes its existence to our ethnic minority staff,” said the former chair of the British Medical Association (BMA), Dr Chaand Nagpaul.
“About 42 per cent of all doctors who work in the NHS come from ethnic minorities, the vast majority from south Asia, and about 26 per cent of all NHS staff are ethnic minorities.
“Now, unfortunately, the statistics show, repeatedly, that ethnic minority staff suffer disadvantage in the NHS.
“They have worse career progression, even though they’re highly capable and talented, they suffer bullying and harassment, about twice the rate of their white counterparts.
“We also know they experience uncivil and discriminatory behaviour, such as feeling excluded at work, having their professionalism doubted, and there’s an ethnic minority pay gap.
“Now, when you put that all together, if you have a leadership of executive directors, of which not a single person is of colour, I don’t think that sends the right message to ethnic minority doctors, nurses and staff who work in the NHS.”
High minority communities
Even in areas which have high black and south Asian populations, senior management teams do not appear to represent the communities they serve.
Nagpaul, who also chairs the BMA’s forum for racial and ethnic equality said, “It’s, I think, quite obvious, that if you have executive directors, clinical leaders in hospitals and community trusts that have got lived experience of being from an ethnic minority, or lived experience of having come to work in the NHS from another country, it stands to reason that there will be a better understanding of the experience of patients who are from ethnic minorities and also of healthcare staff.”
Robust defence
Some trusts with all-white executive directors, which Eastern Eye, contacted defended their position.
They pointed to the racial representation of their workforce and the number of minority non-executive directors on their boards.
The University Hospitals of Derby and Burton NHS Foundation Trust is a case in point.
It does not have a single person of colour in its executive team, but three of its non-executive directors are ethnic minorities – either south or east Asian; none is black.
A spokesperson contended this was proof-positive of racial representation.
“We know that diverse boards make better decisions, and our board members bring a breadth of perspective and lived experience across a wide range of protected characteristics, from race and gender to religion and sexual orientation.
“There is always more we can and want to do and we are absolutely committed to our equality, diversity and inclusion agenda, which remains a core and important part of the board’s focus, alongside our work with partners in our local communities to tackle known health inequalities together.”
Others were equally robust about their ethnic representation.
A spokesperson for The Rotherham NHS Foundation Trust, whose seven executive directors are all white said, “As a trust we are committed to equality, diversity and inclusion, and (we) are working to make sure that our workforce reflects the local population.
“The latest published Workforce Race Equality information shows that overall, 14.2 per cent of our workforce is from a Black and Minority Ethnic background.
“For non-clinical staff this percentage is 4.5 per cent, lower than the local population, and for clinical staff including medical and dental staff this percentage is 17.3 per cent, higher than the local population.
“Whilst we have a number of board members from a BME background and many senior clinicians, we are working to improve the diversity of our broader senior leadership, and our published action plan will help us make more progress in this area.”
Norfolk and Norwich University Hospitals NHS Foundation Trust chief people officer, Paul Jones said, “We are an increasingly diverse organisation, with 18 per cent of our workforce from a BME background.
“We are intensely proud that we have 109 different nationalities represented in our workforce, which is a great source of strength.
“We recognise that this is not reflected in the makeup of our board.
“We want to ensure all staff have the opportunity to be heard, and that our board members understand their lived experiences.
“We have a dedicated diversity, inclusion and belonging strategy which incorporates programmes and initiatives including our staff networks which are chaired by a wide range of colleagues with any concerns raised directly to the trust board.”
Future representation
Others said they had put steps in place to increase ethnic representation in the future.
“As a trust, Hertfordshire Community NHS Trust (HCT), has changed its recruitment practices to improve the ethnic diversity of its main board.
“This year there will be two members from a minority ethnic background, Rukshana Kapasi, one of our non-executive directors, and Marcus Riddell, our incoming chief people officer.”
“The Royal Cornwall Hospitals are committed to increasing the diversity of our board in all respects, including ethnicity,” said a spokesperson for that trust.
“We are participating in the NHS England NExT director scheme which focuses particularly on supporting the development of people from local BAME communities and those with disability, who have senior level experience to bring to board level roles.
“We already have one NExT director working alongside our board and hope to make more appointments in the future.”
Again, NExT directors appear to be observers rather than decision makers.
So, what about the argument that non-executive directors proved that diversity in the NHS was being taken seriously?
“Under the chair and leadership of Professor Laura Serrant, the unitary board at Sheffield Children’s NHS Foundation Trust is satisfied that its current membership allows it to function effectively and that it is balanced, complete and appropriate.
“Three of the board’s 13 members are currently from Black and Minority Ethnic (BME) groups.
“This accounts for 23 per cent of our directors and aligns with the diversity figures for Sheffield as a whole, with 21 per cent of the city being made up of individuals from BME groups.”
Professor Serrant is one of the few chairs of colour.
But the problem with this argument, sources told Eastern Eye, is that NEDs are responsible for making sure the trust is run properly and not its day-to-day decision making.
Disturbing testimony
Eastern Eye has also been given disturbing testimony that some directors of colour are criticised if they try to speak up.
“I was taken to one side after a meeting,” one anonymous NED source told this newspaper, “and I was told in no uncertain terms not to keep on asking questions which could embarrass the trust.
“It was clear to me that they just couldn’t admit or didn’t want to admit that they’d failed black and Asians and didn’t want to be reminded of that at every board meeting.
“I’ll never forget their words, ‘Turn up, listen, have the tea and biscuits, spend a couple of hours, take the money and go home.’”
Another executive director told Eastern Eye, “When we do have a non-white executive or NED, you need to tread carefully to avoid being tarnished with ‘here we go again’.
“We need objective, fair, transparent and consistent processes including opportunities for interim jobs.
“Usually, you get a tap on the shoulder for interim posts, which then advantages certain folk.”
Bradford Teaching Hospitals NHS Foundation Trust has one south Asian executive director, Sajid Azeb, who is also its deputy chief executive.
Almost one in three (32.1 per cent) in the city is Asian.
The peer, Lord Patel of Bradford, is a former chair of the trust.
He told Eastern Eye that non-executive directors can play an important role in helping with diversity and inclusivity.
“Things have improved a little bit, but you’re right, they’re shocking figures,” said the peer.
“How in this day and age, can you have figures still where you’ve got such a disparity in terms of the executives is actually very key.
“The non-executive membership is moving, it’s moving slowly, but there’s a lot of people who haven’t had the experience of being a non-exec.
“I think that certainly, if there was one thing I could do over the next five years is to say we have lots of good young, bright people, people of colour across the board, they need some experience in being a non-executive director, a lot of people don’t have that.
“It’s a different set of skills, because you’re not running things you are overseeing, you’re challenging.
“Now if you’re running a hospital, where you haven’t got people of colour at the executive level, that’s where day-to-day decisions are made.
“When you’ve got 25 per cent or there abouts of the NHS, from black and Asian background, to say you haven’t got even 10 or 15 per cent to make it to executive levels that difficult to stomach in 2024.”
Work culture
For those who work in the health sector, it is the senior leaders who run organisations day-to-day who create the culture for others to follow.
“This isn’t something new, is it?” asked the global mental health advocate, Poppy Jaman.
“If you look at the plethora of leadership papers, research from Harvard, Oxford, some of the world’s biggest business schools, universities and academic institutes, the one thing that we can all guarantee is that they repeatedly show that leadership matters, and diversity of thought in boards creates a huge difference in the way that systems and organisations are run.
“This isn’t an NHS thing, this isn’t a social care thing, this is just general, knowledge that to create an organisation that serves its population, it needs to reflect decision makers or systems that are actually feeding directly into that board or the decision-making part of that organisation.
“So, when you share data like that, I just find it really upsetting because I think, why is that?”
Jaman is also part of the steering committee for an organisation called Change the Race Ratio.
The group campaigns to increase racial representation in leadership roles for businesses.
She questions why there are so few executive leaders in NHS trusts.
“Is it because there aren’t enough black and brown people that are qualified to be on those boards?
“Is it because the outreach for recruitment hasn’t been thought through?
“Is it because people just haven’t thought about it?
“I find that very difficult to believe in the current climate, we’ve had more work around diversity and inclusion for leadership of organisations than ever before.
“So, it just surprises me that those changes haven’t happened.”
What Jaman advocates is for trusts to create talent pipelines.
“The other thing that to think about is how do we put people in those positions of responsibility?
“You need to create a pipeline into those roles.
“You can’t just go, I want a black person in this job, that that doesn’t work.
“Sometimes you see that level of tokenism taking place.
“You need to actually develop people, you need to put in board level recruitment programmes in place.”
Proactive steps
Some boards with no people of colour are trying to encourage racial representation.
Gateshead Health NHS Foundation Trust is an example.
Its group director of people and organisation development, Amanda Venner said, “We are aware of the importance of having a board and senior management team that properly represents the communities we work in.
“While our board does not currently include any person of colour, we actively encourage applications from a diverse range of people and are taking proactive steps to change that by developing a shadow board programme that will positively impact diversity as well as strengthen our succession capabilities.”
But campaigners are concerned that all-white NHS boards could lead to health disparities among minority communities.
The Darzi Review published last month (September) indicated that people of colour face health inequalities.
“Asian people experienced disproportionally longer waits for elective care after the pandemic than those from white backgrounds,” said the report.
“Asian people experienced an eight per cent overall fall relative to white groups in elective procedure rates – with this as high as 23 per cent in therapeutic cardiac appointments.
“Black people also experienced a large drop in some areas, with a 19 per cent drop in cataracts procedures relative to the white population.
“Similarly, in mental health, people from minority ethnic groups experienced worse outcomes; waited longer for assessment; and were less likely to receive a course of treatment following assessment in the NHS Talking Therapies Programme.
“There is a substantial evidence base that shows that people from minority backgrounds are more likely to be sectioned under the Mental Health Act.”
Lack of ethnic clinicians
Another problem is the lack of black and south Asian medical directors.
“It’s really important to have ethnic minority clinicians holding positions, like a chief medical officer position or also a chief nursing officer position,” said the former doctors’ leader, Chaand Nagpaul.
“What we also know is that there are higher levels of disciplinary referrals, unfairly so, amongst ethnic minority doctors.
“You’re twice as likely to be referred to the regulator if you’re a doctor from an ethnic minority background, three times more likely if you’ve come to work in the UK from another country.
“These are devastating experiences for healthcare staff to be actually referred to a regulator, to be scrutinised, to have your professionalism doubted.
“These high levels of rates of disciplinary processes to some degree, we believe, would be addressed if we had a leadership that was more sensitive to and understood the experiences of ethnic minority staff working in the NHS.”
Eastern Eye contacted the Department for Health and Social Care but despite several email exchanges it did not comment.
A spokesperson for NHS England said, “While we have seen some positive improvements this year, with more black and minority ethnic staff in senior positions in the NHS than at any point in its history, we know there is much more to do, and with the NHS workforce more diverse than ever, progress is particularly critical.
“That’s why we have created the NHS equality, diversity and inclusion improvement plan to ensure that people from all backgrounds have the same opportunities to thrive in the NHS no matter what job role they are in.”
Additional reporting by Krishna Bhanu, Aparna Sreevalsan, Chloe Leggett, Maddie Reader, Steven Whitear, Emily Pitt-Shaw, Mia Lutchman and Hannah Foley.
Comment
‘Probe health disparities and board makeup link’
This has been a painstaking piece of journalistic work, writes Barnie Choudhury.
It required a team to scour every trust in England where we looked, not once but several times, at the photographs of those on their boards over a two-year period.
We tried to verify the ethnicity when we were uncertain whether an executive director was of colour.
While some helped us, others told us to use the Freedom of Information Act knowing full well that GDPR (General Data Protection Regulation) rules would prevent their revealing an identifiable person’s ethnicity.
We discounted non-voting executive managers, associate non-executive directors and so-called NExT directors.
Why?
Because no matter what trusts think or say, unless you have a vote, you have very little influence on decisions.
This is made clear in recruitment adverts.
Bedfordshire Hospitals NHS Foundation Trust advertised for an associate non-executive director, at £7,500 per year, in August 2023.
“Associate non-executive directors cannot participate in any formal vote at board,” said the ad.
I was a non-executive director for two mainstream organisations, and from experience, I know that NEDs meet once every two to three months for a maximum of three hours.
Beforehand you are sent documents to read, and then you discuss these.
The agenda is often huge, and even if you bring up your questions under AOB (any other business), the board usually promises to get back to you, and I found little really got done or resolved.
When you are one of a handful of people of colour, you can sense the rolling of collective eyes when you bring up racial representation for what must feel like the billionth time.
So, what about NExT directors.
I’m sure the intentions are good, but the telling phrase in the statement from Cornwall is “hope to make more appointments in the future”.
Some trusts also made great play of their Workforce Race Equality Standard (WRES) report.
It is meant to ensure health workers of colour have “equal access to career opportunities and receive fair treatment in the workplace”.
But as several south Asian sources have told Eastern Eye that “the tap on the shoulder doesn’t come to the likes of us”.
Senior doctors such as the former BMA chair, Dr Chaand Nagpaul told Eastern Eye, they were concerned by the disproportionate nature of complaints and disciplinary action.
The point is that in 2024, no part of England is all-white, and yet some NHS boards are stubbornly so.
An all-white board, and all-black board or an all-south Asian board are not good things.
Quite often it leads to group think because of assumptions made their lived experiences.
Unfortunately, in my honestly held opinion based on personal experience and an absence of malice, many all-white institutions have the arrogance of privilege.
They know they will never be held to account because, for chief executives and politicians alike, tackling racial inequality is always in the “too difficult to do” pile.
They always leave it to someone else.
But it’s about time ministers and the health select committee stop turning a blind eye to what’s happening in their watch.
Trusts with no executive directors of colour
Alder Hey Children’s NHS Foundation Trust
Avon and Wiltshire Mental Health Partnership NHS Trust
Barnsley Hospital NHS Foundation Trust
Bedfordshire Hospitals NHS Foundation Trust
Bridgewater Community Healthcare NHS Foundation Trust
Calderdale and Huddersfield NHS Foundation Trust – 1
Cambridge University Hospitals NHS Foundation Trust
Cambridgeshire and Peterborough NHS Foundation Trust
Cambridgeshire Community Services NHS Trust
Central London Community Healthcare NHS Trust
Chelsea and Westminster Hospital NHS Foundation Trust
Cornwall Partnership NHS Foundation Trust
Countess Of Chester Hospital NHS Foundation Trust – 2
County Durham and Darlington NHS Foundation Trust
Dartford and Gravesham NHS Trust
Dorset County Hospital NHS Foundation Trust
Dudley Integrated Health and Care NHS Trust – 3
East and North Hertfordshire NHS Trust
East Cheshire NHS Trust
East Midlands Ambulance Service NHS Trust
East Of England Ambulance Service NHS Trust – 4
East Suffolk and North Essex NHS Foundation Trust
East Sussex Healthcare NHS Trust
Gateshead Health NHS Foundation Trust
Gloucestershire Hospitals NHS Foundation Trust
Harrogate and District NHS Foundation Trust
Hull University Teaching Hospitals NHS Trust
Kent Community Health NHS Foundation Trust
Lancashire Teaching Hospitals NHS Foundation Trust
Leeds and York Partnership NHS Foundation Trust
Liverpool University Hospitals NHS Foundation Trust
Maidstone and Tunbridge Wells NHS Trust
Medway NHS Foundation Trust
Mersey and West Lancashire Teaching Hospitals NHS Trust
Mersey Care NHS Foundation Trust
Mid and South Essex NHS Foundation Trust
Mid Cheshire Hospitals NHS Foundation Trust
Milton Keynes University Hospital NHS Foundation Trust
Moorfields Eye Hospital NHS Foundation Trust
NHS Lancashire and South Cumbria Integrated Care Board – 5
Norfolk and Norwich University Hospitals NHS Foundation Trust
Norfolk Community Health and Care NHS Trust
North Bristol NHS Trust
North Cumbria Integrated Care NHS Foundation Trust
North East Ambulance Service NHS Foundation Trust
North Tees and Hartlepool NHS Foundation Trust
Northern Devon Healthcare NHS Trust
Queen Victoria Hospital NHS Foundation Trust
Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust
Rotherham NHS Foundation Trust
Royal Berkshire NHS Foundation Trust
Royal Cornwall Hospitals NHS Trust
Royal Devon University Healthcare NHS Foundation Trust
Royal Surrey County Hospitals NHS Foundation Trust
Sheffield Children’s NHS Foundation Trust
Sheffield Teaching Hospitals NHS Foundation Trust
Sherwood Forest Hospitals NHS Foundation Trust
Solent NHS Trust
Somerset NHS Foundation Trust
South East Coast Ambulance Service NHS Foundation Trust
South Tees Hospitals NHS Foundation Trust
South Western Ambulance Service NHS Foundation Trust
Stockport NHS Foundation Trust
Sussex Community NHS Foundation Trust
Taunton and Somerset NHS Foundation Trust
The Christie NHS Foundation Trust
The Dudley Group NHS Foundation Trust – 6
The Hillingdon Hospitals NHS Foundation Trust
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
The Princess Alexandra Hospital NHS Trust
The Queen Elizabeth Hospital, King’s Lynn. NHS Foundation Trust
The Rotherham NHS Foundation Trust
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
The Royal Wolverhampton NHS Trust – 6
The Walton Centre NHS Foundation Trust
University College London Hospitals NHS Foundation Trust – 7
University Hospital of Derby and Burton NHS Foundation Trust
University Hospital Southampton NHS Foundation Trust
University Hospitals Bristol and Weston NHS Foundation Trust
University Hospitals Coventry and Warwickshire NHS Trust
University Hospitals Dorset NHS Foundation Trust
University Hospitals of North Midlands
University Hospitals Plymouth NHS Trust
University Hospitals Sussex NHS Foundation Trust
Warrington and Halton Hospitals NHS Foundation Trust
West Midlands Ambulance Service University NHS Foundation Trust – 8
West Suffolk NHS Foundation Trust
Wirral Community Health and Care NHS Foundation Trust
Wirral University Teaching Hospital NHS Foundation Trust
Worcestershire Acute Hospitals NHS Trust
York and Scarborough Teaching Hospitals NHS Foundation Trust
Yorkshire Ambulance Service NHS Trust
Trusts with no south Asian executive directors
Airedale NHS Foundation Trust
Coventry and Warwickshire Partnership NHS Trust
Dartford and Gravesham NHS Trust
Derbyshire Community Health Services NHS Foundation Trust
Devon Partnership NHS Trust
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Epsom and St Helier University Hospitals NHS Trust
Hertfordshire Community NHS Trust – 9
Humber Teaching NHS Foundation Trust
King’s College Hospital NHS Foundation Trust
Lincolnshire Community Health Services NHS Trust
London North West University Healthcare NHS Trust – 7
Manchester University NHS Foundation Trust – minority executive director is east Asian.
North Staffordshire Combined Healthcare NHS Trust – 10
Northamptonshire Healthcare NHS Foundation Trust
Royal National Orthopaedic Hospital NHS Trust – 7
Shrewsbury and Telford Hospital NHS Trust
South Central Ambulance Service NHS Foundation Trust
St George’s University Hospitals NHS Foundation Trust – 7
Surrey and Sussex Healthcare NHS Trust
Tavistock and Portman NHS Foundation Trust – 7
The Royal Marsden NHS Foundation Trust – 7 and minority executive director is east Asian.
United Lincolnshire Hospitals NHS Trust
University Hospitals of Morecambe Bay NHS Foundation Trust
Walsall Healthcare NHS Trust – 6
Wye Valley NHS Trust
Source: Individual websites NHS trusts in England
Key
1 – This includes Halifax where 14% are non-white and 10% are Asian.
2 – Hospital where the convicted nurse Lucy Letby worked.
3 – Non white = 15%; Asians = 8.4%; Black = 2.5%
4 – Sexual harassment problems – https://www.equalityhumanrights.com/media-centre/news/east-england-ambulance-service-trust-signs-legal-agreement-protect-staff-sexual
5 – Has two south Asian ‘regular participants’ but they have no voting rights. https://www.lancashireandsouthcumbria.icb.nhs.uk/about-us/board/board-members
6 – Sir David Nicholson, former NHS England CEO, is chair.
7 – This is a London trust.
8 – Four non-voting executive directors, one south Asian and one black.
9 – The black executive director does not have a vote.
10 – Trust has a black CEO
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