NHS racism: You can’t tackle a problem if you deny it exists, Earl Howe

Discrimination against ethnic minority NHS staff is rife - and it’s bad for patient care too. The author of a major new report here reveals how the government is misleading parliament by claiming the problem is being addressed.

Roger Kline
11 April 2014

One in five nurses are of Black or Minority Ethnic (BME) origin. But they are being excluded from the 'snowy white peaks' of management - and the government is pretending the problem is getting better when in it's not.

In parliament last month Lord Crisp, former NHS chief executive asked Health Minister Earl Howe “how many Executive Directors of Nursing in the National Health Service are of black or minority ethnic background?”  He was told that there were five, or 3.0% (actually it’s 2.5%).

Earl Howe was then asked about BME managers. He replied:

 “The 2012 NHS Workforce Census identified 8,082 Nurse Managers and 1,241 Nurse Consultants. Of these 606 Nurse Managers (7.8%) and 77 Nurse Consultants (6.6%) classified themselves as being from a Black or Ethnic Minority Background. For Nursing Managers this shows a rise of 0.3% and for Nurse Consultants a rise of 1.2% since 2004. Although these are not substantive rises, this demonstrates that we are travelling in the right direction."

Earl Howe misled the Lords.

The proportion of BME nurse managers peaked at 8.7% in 2008 and dropped to 7.8% in 2012, even lower than it had been (8.2%) in 2003 when his own data started.

2004 can only have been chosen as the reference point because the Department of Health wonks thought it is gave an impression of progress being made. On Earl Howe’s own data, far from there being an increase of 0.3% there has been a fall of 0.4% since 2003 and a fall of 0.9% since 2007, the year after Nigel Crisp left office. The number of BME nurse consultants has risen since 2003 but the proportion peaked in 2007 (again) since when it has not increased at all.

Earl Howe says that his figures show that “although these are not substantive rises, this demonstrates that we are travelling in the right direction.

It actually shows the opposite, especially as the overall proportion of BME nurses all all levels - mostly junior - has risen since 2003 from 16.4% to 19%. Not to worry. The House of Lords was assured that the vast sums of money going into nurse training would help address this scandal.

“Forty-six million pounds has been invested at the NHS Leadership Academy in schemes on leadership development being led by the Chief Nursing Officer. ……The leadership programmes provided by the NHS Leadership Academy will support this diverse talent, ensuring that individuals have the competence and confidence to apply to senior roles, including that of Directors of Nursing in the future.”

In fact because nominations come via the very NHS Trusts who entrench discrimination in the first place, “just 4 per cent of recruits to a nursing leadership course set up at the request of the prime minister are from a non-white background.”

Lord Crisp was asking these questions because a decade ago, in 2004, he launched the Race Equality Action Plan. The evidence since suggests Lord Crisp’s ideas have been largely abandoned. They included:   

a.    “MENTORING: Senior leaders to show their commitment by offering personal mentorship to a member of staff from an ethnic minority - All senior leaders in DH and NHS.”

No one now has any idea how many staff are receiving such mentoring. The Chief Nursing Officer has just launched a new scheme but there is no requirement on Trusts to run such schemes

b.    “LEADERSHIP ACTION: Senior leaders to include a personal 'stretch' target on race equality in their 2004/5 objectives - NHS Chairs and CEs; DH Board members. “

No one now knows how many Trusts are still producing such targets – probably no more than a handful.


The most important national programme, Breakthrough, has been abandoned entirely, without any risk assessment of the consequences.

d.    “SYSTEMATIC TRACKING: Build systematic processes for tracking the career progression of staff from ethnic minorities including local and national versions of the NHS Leaders scheme - All senior leaders and NHS Leadership Centre.”

Earl Howe was unable to even produce comprehensive data on BME Nursing Directors.

He nevertheless asserted that the “priority is to work towards the aspiration that the NHS workforce, at all levels, is representative of the populations that are served”. In fact, no one even has any idea how many Trusts have identified workforce race equality as a priority, nor what that means because there is no central monitoring taking place. There are no incentives to focus on workforce race equality and there are no sanctions for doing so. The NHS now has had a workforce equality strategy almost entirely premised on each individual NHS employer having the same failed responsibility for workforce race equality.

All data and research shows that there has been little or no significant progress on workforce race equality over the last decade by any measurable criteria for the staff employed by NHS Trusts or by the national bodies in the NHS. Earl Howe has been badly briefed if he believes there has been. The NHS remains in denial that there is the most enormous waste of talent, at the expense of patient care, arising from race discrimination in the recruitment, promotion, and treatment of NHS staff. Michael West and colleagues have demonstrated the close link between the treatment of BME staff and the overall patient experience, yet there is no sign of this evidence remotely influencing Government policy.

The impression of progress the NHS seeks to give nationally on workforce race equality misleads Parliament and is dangerous for patients. A problem denied is a problem that will not be solved.

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