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Confronting the glass ceiling

Steps have been taken to promote racial equality and diversity within the NHS, but there is still a long way to go to eliminate prejudice and discrimination
Kin Ly
Assistant editor

The Race Relations Act was amended in 2000 following the publication of the report of the Stephen Lawrence Inquiry. The report had found the police to have been institutionally racist, describing this as a collective failure to provide an appropriate service to people because of their colour, culture or ethnic origin. The 2000 amendment places a legal obligation upon all public sector organisations to promote race equality among staff, and many local and national groups have been created since then to address this within the NHS. Ten years on, institutionalised racism and inequality remain current problems within the NHS. Numerous reports suggest that improvements still need to be made in tackling discrimination, providing quality healthcare services to black and minority ethnic (BME) patients, and ensuring that the workforce is racially diverse across all levels of the NHS. However, while emphasising areas that still need to be addressed, some BME NHS senior managers say that the glass ceiling imposing restrictions on career development has at least been weakened.

appear to be below average when compared to the wider BME population in both senior and middle management roles. In 2007, only 8.3% of NHS staff in senior management roles were BME. Although this had risen from 5.4% in 2004, it is below the proportion of people with BME backgrounds in equivalent positions in the overall population. BME staff made up 10.1% of those in NHS middle management jobs in 2007, which had increased from 7.3% in 2004. But again, this was below average when compared to those in middle management in the general population, 12.1% of whom were BME in 2007.

few BME staff in NHS executive positions, but I do not feel that working at executive level is unachievable for BME nurses. She adds: There is certainly scope for me to develop to executive level if I wanted to because I have proven myself in my current and previous roles, and when I am ready to progress, I would be supported by my manager to do this. However, in other primary care trusts, the support to BME staff to progress to managerial positions is very poor.

health training. At the time, my manager did not take me seriously or put me forward for the training. I had to take the initiative and decided to get directly involved with another community project elsewhere, and only then did managers in my organisation take me seriously. Many BME staff do not feel inspired or motivated to further their careers. Christine states: For various reasons, media representation being one of them, a lot of young BME people are told by families that they will not be able progress to high-level positions, and this puts them off from furthering their careers. She adds: In my previous job as modern matron manager across provider services, I found that on the whole, I was not taken seriously by staff and senior management. For example, often when I gave a presentation on a new initiative, staff would not fully engage and I felt that colleagues did not trust my ability I could not help but feel that this was down to my ethnic origin. I felt that I had to work harder in this role to prove my worth to employees and to senior managers. However, while she has experienced discrimination in the past, Christine feels that progress has been made. She says: There is sometimes an element of discrimination even today, but the situation has certainly improved.

It was Christines ambition and commitment to achieve a higher grade that got her to her current position, and she stresses: I never let the challenges that I faced as a BME NHS nurse affect my professional development, and as a result of my determination and persistence I am now in a very senior position, leading education and training. Through my struggles, I am now more confident and positively challenge any issues with regard to equality and diversity, and now I feel that I can continue moving further up the career ladder.

equality in the NHS.2 Out of the 391 NHS trusts in England, 374 provided evidence that they had implemented a race equality scheme. However, in a more in-depth review, the commission visited 39 trusts in order to examine how well they were promoting race equality. It found that only 25 of these trusts offered BME staff professional development opportunities to senior positions, and trusts that did not provide this information tended not to monitor workforce ethnicity data.

There is sometimes an element of discrimination even today, but the situation has certainly improved
She adds: The best advice that I can give is to be proactive, have self belief and challenge any managers who say no.

Eliminating workplace discrimination Under race relations legislation, all public bodies now have to provide evidence of activity to eliminate unlawful racial discrimination and promote racial equality. Last year, the Healthcare Commission, now the Care Quality Commission, published a report on promoting race

The glass ceiling imposing restrictions on career development has at least been weakened
So BME staff are better represented in NHS middle management than in senior management positions, and the report stated that: This suggests that there may be a pool of talent in non-white staff at middle management level available to increase the proportion of non-white senior management, but which would appear to be hitting a glass ceiling.

Individual initiative Christine stresses that BME staff need to work harder than their white counterparts to progress up the career ladder: The onus is very much on the individual to put themselves forward for managerial positions. Sadly, I have noticed that BME staff were not being put forward to represent a project or service that they are working on in meetings, or were less likely to be recommended for a promotion than their white colleagues. The onus is very much on the individual to take the initiative to seek out such positions. Challenging perceptions It would appear that institutionalised racism still needs to be addressed within the NHS, despite efforts to promote diversity and eradicate discrimination. Christine says: BME nurses were rarely targeted to access any type of extra training to develop professionally. I experienced this when I was working as a health visitor and wanted to access extra public
May 2010 Volume 83 Number 5

Box 1. Awards recognising and promoting leadership in the NHS

Applications are being invited for the following awards:

Mary Seacole Leadership Awards

The award is worth up to 12 500 each and provide the opportunity to: I Undertake a specific healthcare project I Enhance personal, leadership and communication skills

Mary Seacole Development Awards

The award are worth up to 6 250 each and provide the opportunity to: I Undertake a project that benefits the health needs of people BME communities I Develop leadership skills

Inspiring BME leaders A number of national and local NHS initiatives to promote race equality and to improve BME representation in senior and executive roles have been developed. These include the national Breaking Through programme, offering training to develop senior and executive managers, and due to be launched in June is the NHS BME Network, a body representing BME health service staff. Locally, trusts have set up working groups specifically to address issues affecting BME staff and patients. In addition, developing NHS leaders has become a key focus within public health, particularly with the Healthy Child programme highlighting the need for practitioner leaders. A number of awards recognise leadership among NHS staff, including the Mary Seacole awards that celebrate good practice in relation to BME health services (see Box 1). Steps have been taken to address issues around institutionalised racism within the NHS. Organisations are now monitoring the efforts of individual trusts, and nationally and locally initiatives have been implemented to support this. However, it is clear that many improvements are needed as institutionalised racism still exists.
For further information For details on the NHS Breaking Through programme, please see: I For more information about the NHS BME Network, see:

Application deadline is 25 May, for further details and to apply email: or see page 45


Below average BME representation The latest report on the access of BME staff to senior positions in England, published last year,1 focused on staff in middle management and senior positions, and acknowledged that anecdotally there were lower numbers of BME individuals in executive roles. The figures do indicate a year-on-year increase of BME staff to these positions, but the figures for the NHS

The MacQueen Award 2010

In recognition of excellence in leadership, the winner will receive 3000 to enable further development, dissemination and publication of their work, as well as a place at Unite/ CPHVA Annual Professional Conference 2010 The deadline is 1 September, for details email: or see page 34

NHS Leadership Awards 2010

There are nine categories, including: I NHS Community Leader of the Year I NHS Mentor of the Year I NHS Quality Champion of the Year The nomination deadline is 28 May, for more details please see:

1 NHS Institute for Innovation and Improvement. Access of BME staff to senior positions in the NHS. Coventry: NHS Institute for Innovation and Improvement, 2009. 2 Healthcare Commission. Tackling the challenge: promoting equality in the NHS. London: Healthcare Commission, 2009.

Breaking the glass ceiling However, opportunities do not appear to be as scarce as they used to be. NHS Leicester City education and development lead Christine Wint states: There are very



May 2010 Volume 83 Number 5