Developing a workforce that reflects the community it serves has become a key goal for many public sector organisations, and the NHS is no exception. The Positively Diverse Programme is a national initiative aimed at helping NHS employers to build, manage and retain a diverse workforce. The Royal Free Hampstead NHS Trust is one of just nine lead sites across the UK chosen to deliver it.
As the trust does not have an equality adviser in its 20-strong HR team, Hilary Nightingale, assistant HR director, has absorbed the management of its diversity initiatives into her role and is spearheading a set of new programmes with HR director Nigel Turner.
“We were chosen as a lead site on criteria such as being able to train other sites and run regular network events. It’s a way of showcasing what we’re doing and sharing best practice by networking with other organisations,” Nightingale says.
The Royal Free has already led training for 25 other NHS trusts. “We are currently working to review the training being offered in other trusts,” says Nightingale. “What it’s not about is explaining to individual managers what the equality legislation is. We’re focused on bringing about strategic change to the organisations.”
The team is now looking to make more progress with the launch of an equal opportunities action plan. Figures from the trust’s equal opportunities monitoring, published in its annual report this June, reveal that there is significant under-representation of people from minority groups in more highly paid roles. For example, 23% of junior (grade D) nurses are black, while just 4% of (more senior) grade H nurses are black. More than 90% of senior nurses are white.
Other figures show greater proportions of white applicants being appointed than applicants from minority ethnic groups. Of those applying for posts with salaries between 18,301 and 25,000, 34% of applicants were of Asian ethnic origin and 22% were white. However, just 15% of appointees were of Asian ethnic origin and 42% were white.
Developing networks
It is vital that the trust is seen to be addressing this imbalance.
“Historically in the NHS, ethnic minority groups seem to be clustered in the lower salary bands. We are publishing and communicating our figures – we’re quite prepared to say this is where we are and this is what we’re doing about it,” says Nightingale.
To address this, the trust is planning to develop its black and ethnic minority staff network, launched in May this year. The idea behind the network is to provide a range of events to help staff focus on their career development and give them access to mentoring.
“Specific activities will depend on the needs of the people in the group, so it will be needs-driven and led by group members rather than by HR,” she says.
The trust has also tried to address the issues facing refugees searching for work. The Refugee Assessment and Guidance Unit is run by London Metropolitan University and aims to promote access to employment for refugee healthcare professionals. The Royal Free became a pilot site, providing work placements for the project between May and December 2004.
“Nine refugee healthcare professionals came to work in our laboratories and on the wards. The people who came to us were skilled and qualified in their country of origin, but lacked the expertise to get work in the UK,” explains Nightingale.
She adds that refugee candidates are often turned down for work in the NHS because of a lack of understanding of the work culture, rather than lack of skills. “It is about understanding what it is like to work in the UK and also the workings of the NHS, which can be seen as complex and hierarchical by people who have never worked in this country before,” she says.
Nightingale found that other staff responded positively to the work placements and feedback from managers was equally constructive. “It helped them to better understand some issues that refugees face when they come to the UK,” she says.
The real success of the programme was seen in the permanent recruitment of two of the pilot project’s candidates. “The idea of the programme wasn’t necessarily to take on staff, but we did take on two out of those nine refugees and it is possible the others have gone on to work elsewhere in the NHS. It has certainly improved their employability,” adds Nightingale.
Future funding of the project has not been confirmed, but Nightingale is eager to get involved should the opportunity arise again in the future.
In its role as lead site for the Positively Diverse Programme, Royal Free has been given specific responsibility to pioneer new methods of equal opportunities monitoring. “We already carry out extensive monitoring. Now we’re going to look at making further improvements,” says Nightingale.
“Specifically, we’re going to monitor people who don’t turn up for interview or who decline offers of employment. We’re also going to monitor internal and external training attendances – something that all public sector organisations should be doing more thoroughly,” says Nightingale.
Monitoring initiatives also include improving the quality of how shortlists and appointments are recorded. “It is hard to get any sort of recruitment analysis from other NHS trusts, such as a breakdown of ethnic minorities. This is true of the private sector as well. We’re looking at developing a matrix for managers to help with the interview process,” Nightingale explains.
Indeed, an interview matrix form could be developed to help managers document how applicants meet selection criteria. If this initiative goes ahead, it will be backed by a scoring system based on this recorded evidence to assist managers in making recruitment decisions.
Managing harassment
The Improving Working Lives standard is an NHS model of good HR practice, where employers have to provide evidence that they are making efforts to improve the working lives of staff.
As part of a series of initiatives to meet this standard, the trust is focusing on ways to better manage harassment. Key to this will be the introduction of internal harassment advisers. These will be volunteers from within the trust who are willing to be trained as advisers to act as mediators in harassment cases.
“We have a well-established harassment policy and procedure for staff who feel they are being harassed and for managers who have to deal with it. But now we’re trying to provide additional support to staff in the workplace to help ensure the harassment or bullying stops,” says Nightingale. “We’re training staff to work closely with individuals to act as advisers. We’ve asked for volunteers and everyone is welcome to apply.
The criteria include the ability to communicate effectively, to remain impartial, and a commitment to undertake training.”
Nightingale says that using trust staff – rather than external mediators – should have many benefits. “Internal people will understand the structure and culture of the organisation, have empathy with colleagues and will know how to direct people to the appropriate trade union representative or manager,” she says.
Another key area of Improving Working Lives will be rehabilitation. Early retirement due to ill-health is not as common as it used to be in the NHS.
However, Nightingale says the trust is aware of how much it costs. It is, therefore, reviewing its rehabilitation policy so it is geared more towards intervention by the trust’s occupational health unit. “The policy will be aimed at helping individual members of staff to return to work following an accident or illness. We’re trying to be much more proactive,” she says.
One specific problem the trust faces is the number of nurses who have back injuries. “They are fit to come back to work, but not in their original capacity. So it’s about re-employment of these staff and getting the best possible fit. The NHS spends a lot of money on training staff. We need to make sure they find a career path, are happy in their new role and their skills can be used as much as possible so they are still of benefit to the organisation,” says Nightingale.
Rehabilitation may not be the first area you think of when it comes to diversity but, to Nightingale, this illustrates an important point. “Some people see diversity as part of equal opportunities, but it’s much broader than that – it’s about valuing everyone as individuals and in the NHS it’s about recruitment and retention of staff. We need to make everyone feel valued,” she says.
The broad scope of the Royal Free’s diversity initiatives and its success to date has undoubtedly been supported by the buy-in of staff and, crucially, the board.
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“Diversity is an integral part of everyone’s job here,” says Nightingale. “Staff do seem to understand the benefits diversity brings to our organisation. Our equal employment opportunities report, which outlines all our plans for diversity over the next year, went to the board on 30 June and the directors see its value and have given the initiatives their full commitment,” Nightingale says.
The key to continued success, however, lies in keeping up this momentum to stay one step ahead. “Action that we take should not just be based on legislative requirements but on our own research and information,” says Nightingale. “We’re on the right track, but we have to persevere and never become complacent.”
The Royal Free’s diversity initiatives
- Being a lead site for the NHS Positively Diverse programme
- Training 25 other NHS trusts in the Positively Diverse process
- Launching a black and minority ethnic staff network
- Providing work placements for nine refugee health professionals
- Developing new methods of equal opportunities monitoring
- Establishing workplace harassment advisers
- Developing a new rehabilitation policy
