Jeremy Dawson is a Professor of Health Management for the 91̽»¨ University Management School. His research, which cuts across both his position in the Management School and the School of Health and Related Research (ScHARR), aims to enhance the experiences of black and minority ethnic (BAME) staff within England’s National Health Service.
The NHS Workforce Race Equality Standard (WRES) requires each NHS trust in England to report data on nine metrics which illustrate the experiences of BAME staff compared to their white counterparts. The standard has been in place for almost five years and Professor Dawson is embarking on the next phase; helping to make cultural changes across the organisation.
‘By improving the experiences of staff working within the NHS,’ said Professor Dawson, ‘it not only creates a more effective workforce and enhances retention, but it also improves the quality of care that those staff members deliver.
‘Of course, it isn’t as simple as that. But by tackling one area at a time and trying to embed cultural change, we can make a difference over time. What I do is a small part of the bigger picture, but it’s a part which I believe is important.’
As a result of the NHS Workforce Race Equality Standard, and of other initiatives such as the Workforce Disability Equality Standard and the creation of the NHS Race and Health Observatory, many individuals, teams, organisations and national bodies in the NHS are now working hard to create climates of fairness, inclusion, compassion and equality. But every individual, team, leader, organisation and overseeing body must make comprehensive and sustained efforts to do the same, says Professor Dawson.
‘The NHS stands for valuing, caring, quality and compassion for all and it is a source of great pride to the people of the United Kingdom. It is necessary therefore that the whole of the system takes responsibility for solving the problem in order to continue to safeguard the founding values of the NHS.
‘It will take concentration, vigour, courage and persistence to ensure this change is effected and sustained over time. Now is the moment to begin.’
With a team of researchers across the Management School and ScHARR, as well as collaborators at the University of Liverpool and the King’s Fund, Professor Dawson’s work began with an analysis of data from the NHS Staff Survey, which included responses from over 255,000 individuals across almost 300 organisations, to assess the scale of the problem before drawing on wider work on climates of inclusion to suggest comprehensive strategies to bring about lasting and pervasive change.
In late 2019, an evaluation of the NHS Workforce Race Equality Standard by Professor Dawson and his colleagues showed that ‘trainees’ perceptions of the WRES Experts Training Programme were largely extremely positive, talking about it with enthusiasm and describing it as engaging and transformative.’ The Workforce Race Equality Experts gained key skills through the training programme, including cultural intelligence and confidence in having difficult conversations about race.
The main barrier, however, was perceived to be capacity, with lack of time more important than lack of money. ‘Experts may have excellent ideas about how to make changes in their local organisations that could make a real difference to BAME staff, for example setting up mentoring schemes, or changes to recruitment procedures, said Professor Dawson, ‘However, the pressures of these experts’ day jobs (and the lack of a support team to help with implementation) means that this knowledge is difficult to convert into real change.
So how do we help to bring about lasting and pervasive change? ‘First we have to assess the scale of the problem before drawing on wider work on climates of inclusion to suggest comprehensive strategies,’ Professor Dawson said. ‘In analysing the data, we wanted to understand what the differences are in experienced discrimination between NHS staff from different demographics and work backgrounds, and how do these differences persist when controlling other background variables such as ethnic group, gender, occupation etc.
‘In answering these questions, we found that there is a clear and compelling need to cultivate a more diverse and effective NHS leadership. The moral arguments against discrimination are clear. The human costs are huge. The impact on patient care is clearly negative and substantial. And we feel that if staff experience discrimination as a result of their identity as gay or Muslim, or disabled, or Black African, there is no doubt that patients who are members of these groups will experience similar discrimination.
‘Although there is great support for this nationally from the WRES team, many of the solutions have to be more locally led, where the context of the specific organisations can be taken into account. This way meaningful conversations with staff groups from different backgrounds can be used to develop initiatives that will work in those organisations. However, these need to be fully backed by senior leadership and boards in those organisations, and they need to lead by example.’
Professor Dawson and his team will continue to work with the WRES project and new NHS Race and Health Observatory to devise initiatives that can be applied across the organisation to improve equality equality and diversity for all working in the NHS.