Our NHS People

Reflections on practice

In this section of the Caring4NHSpeople webinar a group of experts were brought together to discuss the situation BAME colleagues are working in and what can be done in both the short and long term.

These were:

  • Yvonne Coghill CBE, Director of the NHS Workforce Race Equality Standard
  • Marie Gabriel, Chair of the WRES Norfolk and Suffolk FT/ North East London STP
  • Dr Navina Evans, Chief Executive, East London NHS Foundation Trust

The first speaker is introduced and invited to give a short background to establish their context on this issue.

Marie: [00:00:03] So my background really is as an activist, initiated by my father who believed everybody has to create a change and their own contribution to a wider revolution to make a difference. And so for quite a long time, I started out my life, employment life, in time of social justice, anti-racist organisations, And I was spotted / head-hunted by somebody who saw my potential in a way that I didn’t see – someone who Baroness Elaine Murphy encouraged me to become a non-executive director, which initially I was very upset about the thought I’d be pulled inside the tent, but then realised, when I did take on the role that you have a really unique position as an activist to change things from within an organisation. You know, maybe even more so than them than without. And so my journey into non-executive board leadership roles began. But, my core motivator around social justice equity and, I’ll be honest, was a specific interest in anti-racist work, I was able to continue to do that and actually try to work with the NHS to actually become a better employer for all of its staff. And so my current roles are – I have three that I have to talk about here. So I’m just stopped being chair, at East London Foundation Trust. And I now chair the Northeast London SDP. I am chair at Norfolk and Suffolk Foundation Trusts. And of course, I’m chair of the WRES SAG, which is Strategic advisory Group. And within each of those roles, maintaining and ensuring the voice of all our staff and those that we do not always hear or respond effectively to, a key part of our strategy. [00:02:07][124.5]

Helen: [00:02:10] Thank you, Marie, so much. And, you know, one thing I take from for many things, from just that short contribution is about the importance of senior leaders like Dame Elaine finding people and mentoring and supporting. And what a difference that can make. I mean, it’s life changing for you. And so, you know, how many more of us could could do that? So. So thank you. Thank you. And then I really look forward to our conversation and Navina. Yeah. Wellcome Navina as well. So tell us a little bit about about your story. You know, the sense I get in, you know, very much in East London with a very, very diverse workforce. Tell us a little bit about some of the story in the sense of how you’ve worked with diversity and inclusion and supporting the well-being of everyone because of embracing by diversity and inclusion. [00:03:11][61.1]

Navina: [00:03:12] Thank you, Helen. Can I also start, please, with giving a little bit of my background? [00:03:15][3.2]

Helen: [00:03:16] Of course. I want you to. [00:03:17][0.8]

Navina: [00:03:17] I am looking at sense of getting from them with that, he said. So I think it’s really important. I am that everyone. It’s wonderful. I can share my story with, what, 500 people, perhaps?. [00:03:29][11.7]

Helen: [00:03:30] 700 or more. [00:03:31][1.5]

Navina: [00:03:32] So I’m I am an immigrant and I grew up in a country in Southeast Asia where race was a really important thing. And and it was very openly: you were categorised by your race and it was it was it was ‘policy’ – it was the way things were done, certain races did this, certain races that certain race did this – that was that was it. So it’s always been something in my life and something that I’ve been really aware of also. Therefore, I’m really aware of what disadvantage comes along with people’s perceptions based on your race, the colour of your skin or your ethnicity. And there is and, you know, there’s plenty of research. Yvonne and others have talked about this. I don’t have to go into it. It is an integral part of who I am. And for me, getting to where I am now, which is a position of enormous privilege and considerable influence and power is hugely, a huge responsibility and one that I think I have to use really wisely. [00:04:44][71.1]

Navina: [00:04:45] Being a woman and being an Asian woman is always, always, always part of what I am. Whenever I speak, whatever I speak about or whatever I do. And it’s inevitably part of how I how I lead. And I think I strongly identify with the communities that we serve, both in East London and in Bedfordshire, in Luton. I think I always say this to people at induction. I really identify with people who are a little bit on the fringe or who are marginalised. But there’s also something really powerful and vibrant and rich that people who are on the fringe and marginalised can bring to society or to a system or to organisation. And that’s really exciting. [00:05:30][44.8]

Navina: [00:05:31] So we also have a lot of strengths that we have a lot of assets to bring. It’s not just about, you know, injustice. It’s also bringing out what we can offer. And so with that in mind, I think what I feel about how I lead in our organisation is really, really focussed on the culture of the organisation. And so and I’ll declare now that up until recently Marie was the chair and I was the chief executive of the same trust. And, you know, and I think that I’m really grateful. Like her I had opportunities that people helped me along and helped me to get places where I didn’t think I had the right to be. Well, I didn’t think that, you know, surely they wouldn’t want me there. I’m going to a job in October in Health Education England. And I actually did also think, surely that’s not the job for me. Oh, that’s not a job for someone like me. Not me. That is not a job for someone like me. Well, we’ll see! [00:06:32][61.0]

Navina: [00:06:34] So it’s really important in our organisation that we build a culture where we actually challenge some of our preconceptions, that we truly value everyone, that we we talk about assumptions and that we try and break down those sorts of assumptions and prejudice because it exists everywhere. And we all we all at one point or another will succumb to to it. And we need to be able to be brave enough to speak about it openly and so that we can actually tackle it. [00:07:09][34.6]

Navina: [00:07:10] Shall I stop there? And then perhaps when we come back, can elaborate? [00:07:14][3.8]

Helen: [00:07:15] Yes, that’s fantastic. And I think that, in a sense, we’ve had a call to action, an opening statement from all three of you. That is, um, that that is fantastic. [00:07:25][10.6]

Helen: [00:07:26] So the first thing I want to ask I’m gonna ask to go straight to it. Okay. Which is and you know, just just hearing what you’re saying and I mean all of you really. And you know this and people are saying to me, OK. And some I’m White colleagues and senior leader colleagues are saying to me … I feel. erm, you know, not what’s happening at the moment to our BAME colleagues is, you know, it’s really awful. And, you know, it’s about it’s about justice. It’s about inequality. And we’ve got to tackle it. And at the same time, I, as a white leader, feel quite uncomfortable and talking about it because – not because I don’t believe that we’ve got take action now, but because I’m really frightened I’m going to say the wrong thing or do something offensive. So but can I ask all three of you, you know, practically, what advice do you give to, um, you know, to leaders in that in that situation? Because a lot of people are thinking of even if they’re not saying it. [00:08:31][65.5]

Marie: [00:08:33] So I think that all three of us, it’s Marie here. I think all three of us get asked that question as to what, and I think. All – as in any situation, a leader has to be honest; they have to be vulnerable. They have to be authentic. But the starting point of this is I am worried. I am concerned. And I am sad that I am losing a disproportionate member of my of my team or more are dying. And then within that team, I include agency and subcontracted workers who we’re not always [thinking] about in terms of who Covid or inequity can affect. I think it is about them working with, them BME networks, with the WRES expert leads that we’ve been spread in a trust with the WRES team, and with BME colleagues to actually ask “how do we fashion the narrative?” And I know that each of us have helped people to think through that. So it’s still authentically theirs and relevant to that person’s organisation. But there’s a narrative there. I think that if that leaders get worried about is if I single out BME staff, am I seen as privileging that group of people or am I making things worse? And even BME staff that I’m comfortable with that, to be honest. I think it’s really important to be clear that this conversation is about unity, it’s about equity. It’s about making sure that everyone is included. And that will benefit all. And actually that the relationship between the quality of services and the experience, the stock, typically BME staff. I’ll stop there and my colleagues come in. [00:10:15][101.6]

Navina: [00:10:18] Shall I go next? [00:10:18][0.6]

Helen: [00:10:19] Yep. [00:10:19][0.0]

Navina: [00:10:22] The first thing you said was that you are you’re nervous, you’re anxious, you’re afraid you might say the wrong thing. And through the screen there is emotion and there’s a connexion and there’s authenticity. So the first thing I would say is, you know, I wish that more of my colleagues would say that. And I think as leaders, it’s quite hard sometimes to admit that you don’t and you don’t know what to do. And you might get it wrong. And I think that that’s a really good start. And as Marie says, with authenticity. The other thing is that if you have a BAME Network, that’s a really good place. So I was interested in that poll that said some organisations that they need to have a BAME network. Well, I’d be very keen to go and have conversations with those organisations to perhaps have a discussion about why this matters. And if you do have a BAME network as as a leader, as a white leader sitting there and being able to just listen and not feel you have to fix it straightaway, and ask for help. I think that’s that’s a really good place to start. [00:11:34][72.2]

Helen: [00:11:35] Thank you. Navina. Yvonne, what wisdom would you add? [00:11:38][2.7]

Yvonne: [00:11:41] So I… when I first started down the road of doing this work, it was really, really interesting because I made the assumption that people would know what to do, that they would be able to know that staff were having a difficult time and that they would as senior leaders, be that, and know that there was something that they needed to do. What I now know is that a lot of people don’t know what to do and they are uncomfortable and they do feel awkward around this agenda. And I think the most important thing that senior leaders can do is talk to their staff. I remember going into the Royal Free, and I will name him because he actually did this Dominic Dodds was the chair. And David Sloman, who was chief executive at the time, and I can remember saying, you know, you have to talk to your staff and so Dominic, he walked the corridors and he stopped staff and he asked his BME staff. What? How can I. How can I help? What can I do? Because it was probably year two of the WRES data. And the staff actually sat him down and spoke to him and told him exactly what was going on for them and Dominic said that he was so shocked he had never heard anything like it in his life. So that the advice I would give it would be to ask and listen. Those two things are really important, because I think a lot of the time leaders think that they need to have the answer, and the answer usually comes from their staff and those people who are experiencing difficulties or or discrimination or whatever you want to call it. So listen and ask. [00:13:12][91.8]

Helen: [00:13:14] OK. Thank you. I’m just going to give notice to Louise in the chat box. I’m going to and I’m gonna get you to ask that. And the next question after this one. [00:13:26][11.6]

Helen: [00:13:29] So my next question is going to be, given it is a conversation, in terms of what you heard from each other. OK. Would you like to comment on something? So Navina would you like to comment on something that Yvonne said? And then Yvonne to comment on something that Marie said and then Navina to comment on something that Marie said. Okay? [00:13:53][23.4]

Helen: [00:13:57] Yeah. So Navina, do you want to comment on something that Yvonne said. Yeah. [00:14:01][3.9]

Navina: [00:14:02] And actually Yvonne it’s a it’s actually a conversation that we’ve been having outside of here. Many of our colleagues have been very, quite open with us about the “not knowing”. And I think that that is something new that I have seen Yvonne, and I don’t know if you would agree with me, but you said that when you first started this work, you assumed that that would be that people would know and they were leaders and that they fix problems. That’s their job. But actually, that for a lot of people, it’s… they don’t. And I think the words that have been used to describe it to me is “because I haven’t lived your experience. I haven’t lived that experience. You know, I unless I am confronted with the stories or unless I hear the reality, you know, looking at the data, and data is very important, and all of that is very important. But it needs to connect emotionally. And that’s why I think sitting in a BAME network and hearing, hearing from people and asking and listening is so important. I’m a great believer in stories. And that’s what I heard from you, Yvonne, which I think absolutely with you. I think more and more people are acknowledging that. [00:15:14][71.8]

Helen: [00:15:16] Yeah. Yvonne would you like to comment on something you heard Marie say? [00:15:21][4.7]

Marie: [00:15:24] Remember. I’m your chair, remember? (laughter) [00:15:26][1.9]

Yvonne: [00:15:30] I can’t remember all of it. But what I think I heard you say was that it’s really important to engage with your staff and to make sure that you are authentic and to bring your authenticity to the table, to the fore and to be yourself, because being yourself means that you can engage with with people and they will see that you were being genuine and being real and that you’re genuinely interested and care for them. So I think that authenticity thing is really important. [00:15:59][29.8]

Helen: [00:16:02] And then Marie, (yes). Would you like to comment on something that you heard Navina say? [00:16:07][4.7]

Marie: [00:16:08] And actually, I think Yvonne and Navina talked about really, you know, that engagement with Star. And I think, you know, completely and absolutely agree, and what I would add to that is the response in return. So it’s good to listen. It’s good to listen with curiosity, it’s good to be authentic, but actually, then you got to do something. And it’s about what you do together to create the change that you need to see, you know? And some of that stuff can be really immediate. So we know when Covid started, it was like there were no black people in all the images that worked for the NHS. You know, so some of that can be really quickly, sort of like addressed. But actually, it’s about making sure this is just not a Covid conversation. So at the very beginning, Zoe was talking about, you know, now and into the future. We are now, all of us, going to be part of recovery, and resetting the NHS conversations and what we need to make sure is this equity conversation, the voice of all conversation, and the need to address inequalities wherever they exist, is a core part of the resetting of the new new NHS post Covid. So that all the things that we’re learning together, about making sure that we’ve got diverse talent, actually, the things we knew from before about making sure WRES is embedded and read in your organisations become a core part of your organisations, in your discussions with your partners and in discussions of your SDPs as well. [00:17:43][94.2]

Navina: [00:17:45] Can I just pick up on something that Marie said, which I think is clearly important? Because I think Marie’s just reminded me and hopefully all of us, that Covid appears to be amplifying what we already knew was happening. It’s such of just made it kind of more stack, bigger and more – there’s a sense of urgency about it. And a lot of a lot of the issues that are being raised, the stuff that we were grappling with or we thought we were grappling with before now through the WRES, through lots of other equality and diversity and inclusion work, through our recruitment, disciplinary, sickness, management, all of those things. You know, we’ve been thinking about it for some time. And I know in my own organisation, we’ve been grappling with it – it’s been in my objectives. So this is just sort of made it kind of almost like raw and really, really open, and you’d have to confront it in a way, perhaps in the past we could tread gently or tiptoe around it. [00:18:54][69.7]

Helen: [00:18:58] Yeah. Thank you so much. And, you know, and I think, you know, it’s amazing when you look you know, we’ve got about 700 odd people across our platforms today and that are all, you know, we’re all thinking about this, We’re all listening. Absolutely. I’m hearing. Hearing this message for action so that we’ve got a little… We’ve got a few minutes left. So I was going to call on Louise. Louise, have you got a question from the chat box that our and our panel can answer fairly quickly? [00:19:26][28.1]

Louise: [00:19:28] Lots of questions in the chat, but I know it’s so hard and there’s been some great conversations on here. So thank you, everybody, for your contributions. Lots of exchanges back and forth. I am stuck between two, but I think a really important one that’s just recently come through. Obviously, this is raising the question around health inequalities at a societal level. So there’s obviously a part that organisations can play in contributing to the good health of their workforce and specifically redressing some of these health inequalities. How do we ensure that that level of interest lasts, post-Covid? That was Alexandra. [00:20:07][38.7]

Marie: [00:20:13] Really good question – that’d be Alexandra, wouldn’t it? So could I go first Yvonne? [00:20:19][6.3]

Marie: [00:20:21] This is what I was trying to say about there will be a new there’ll be a resetting of the NHS after this. And what we have to fight for is actually the inequality, health inequalities are a core part of that resetting of the NHS. So addressing the balance around health inequalities has actually not, in SDP land, has not been as important – I’m being really honest as the finance bit of it or the transformation bit of it. But none of those will work unless we actually start to address and health qualities. And we’re all being very kind, but I actually think that we need to hold leaders to account for this in the same way that we’ll hold them to account to balancing in the books. We know we need to hold them to account in a probably more rigorous way about addressing equality and health inequalities.. [00:21:14][53.2]

Yvonne: [00:21:17] Thank you. Well, I kind of…, I always agree with my chair, but I kind of disagee, because my glass is half empty… I’ll tell you why. These inequalities didn’t happen overnight. We know that it’s taken 400 years or more to get us to where we are with black people at the bottom of the pile and white people at the top. We know that most of the wealth of the world is how is held by white people. We know that more poor people in the world are black and ethnic minority backgrounds. And we know that the health inequalities – Marmot did another study recently – are vast and wide. [00:21:53][36.2]

Yvonne: [00:21:54] And we also know that people’s attitudes and beliefs are more to the right of centre than they are to the left. And we know that in this country. And we know that in America, based on recent things, let’s call them that. I do want to use the B word. But we know that that’s the issue. And I’m not 100 percent convinced that. I mean, at the moment, everybody is jumping up and down. It’s really a fact. It’s awful. It’s terrible because we’re losing lives. But I keep on hearing people saying we want “to go back to normal”. We want to go back to normal. Now, what does normal look like? Normal for black and ethnic minority people in the NHS is not the good news. The WRES data has shown that over the last five years. So if we are going to go back to normal, it means going back to that. And I would suggest that unless leaders really, really take this seriously, then we are going to go back to “normal”. So I’m not 100 percent sure, though, if the reset is going to be any different to what it was. But I am hopeful – how about that? [00:23:02][67.6]

Helen: [00:23:03] Thank you – and lastly to Navina. Are you hopeful? [00:23:05][2.5]

Navina: [00:23:07] So I don’t think we can ever go back to where we were before. It’s just not going to be possible. But I think… What I’m concerned about is that there’s an opportunity here that we miss. However, it is a moment where a lot of us, and there are enough people, I think, to galvanise around and really make things happen at a different way, at different levels. So some people need to be challenging to leaders. Some people need to tackle the sort of politics of it. Some people need to hold on to sort of the improvement, the education making small changes, good things happen from the bottom up. And as we know in the improvement world, that small change happens and then it spreads and it spreads and it spread. So I think that we we need a sort of efforts at every level to make this happen. And there is enough of a collective desire for change for us to ride this wave. But those of us who have the ability to make something of this, I think it is incumbent on us not to sit back and just be kind of down and, you know, go doom and doom about it. We have a responsibility to make it happen. [00:24:18][71.9]

Helen: [00:24:20] Very good. Thank you. Absolutely. Hear, hear. And given that, you know, I’m and I’m running over and and Zoe’s going to be angry with me but I’ve got the floor, so I’m just going to do it. So just like in in in maybe one breath each to finish, okay? Given that and the people on our webinars, like really practical things. Hey. So. So and you know, and again, this could be a [???] enforcement or somebody said before or something you’re going to say already. What’s your number one piece of practical advice in terms of the health and well-being of our BAME colleagues workforce going forward? [00:25:05][44.7]

Yvonne: [00:25:08] Okay. So for me, it’s got to be practical, demonstrable leadership, like the chief executive down in Somerset, who took it upon himself to write the email to his staff, even though, you know, people thought it was awful and terrible and dreadful, but demonstrable leadership meant that a lot of people actually sat up and took notice. And actually, he is doing something for us. And it made people feel much better. So that’s really important. I believe. [00:25:32][23.5]

Helen: [00:25:35] Yes, it’s very good. And I know you definitely met my criteria there – and then Marie? [00:25:38][3.6]

Marie: [00:25:41] So mine would be actually working alongside those who feel it and know it. And actually. So not just listening, but working with them, and actually allowing them to take… not allowing. But, you know, give them space, let’s take the power to make, you know, to create the change within your organisations. [00:26:01][20.0]

Helen: [00:26:03] Thank you, Marie. And Navina, finally. [00:26:05][1.9]

Navina: [00:26:06] Yeah. So I think that for both for being BME staff and for leaders, there are there is a relationship that needs to work here. It’s not good enough to write policy or guidance. I think we have to have to have the conversation. And the conversation has to consist of having the difficult conversations, listening to what’s scary and then asking people to come up with what would work, what could help, and then making it happen because you’d be surprised. It’s actually mostly quite simple stuff. [00:26:39][32.7]

Helen: [00:26:42] thank you all. And I know there’s an amazing amount of content and wisdom in the chat box as well. [00:26:47][5.4]

[00:26:48] And we have to find a way of and not just reflecting on the conversation we’ve had there, but also the parallel conversation that’s been going on in the chat box. So I really want to thank Yvonne and Marie and Navina and for that conversation and and your wisdom [00:27:07][19.4]

Key themes

From the discussions above three common themes were identified to gather these reflections on effective practices and are summarised below. Please note this ‘guide’ is not a policy or reference document – these are informed views from experienced practitioners offering practical advice on making improvements which can help to produce effective changes quickly and pragmatically.

Being authentic as a leader

Good leadership includes being honest, vulnerable and authentic. As leaders, it’s hard sometimes to admit that you don’t know what to do and that you might get it wrong:

“if I single out BME ‘stars’ am I seen as privileging that group of people, or am I making things worse? Be clear that that conversation can be about unity, equity and it’s about making sure that everyone is included and that will benefit all”

Marie Gabriel

Some key things to remember here include:

  • Leaders don’t have to have the answers as soon as they arrive
  • Good leadership is about discovering the answers – listen to the people involved in the realities of the problem or issue
  • Look for ways to connect with people emotionally – asking and listening can be very effective
  • Have open and honest conversations – ask questions of BAME colleagues and truly listen to the answers
  • A “BAME Network” has been recognised as a good place to listen to issues

“It’s really important to engage with your staff and to make sure that you are authentic and to bring your authenticity to the table, to the fore, and to be your self because being yourself means that you can you can engage with people – and they will see that you were being genuine and being real, and that you’re genuinely interested in care for them so I think that authenticity thing is really important”

Yvonne Coghill, CBE

It’s good to listen and to do so with curiosity. It’s good to be authentic but then you have to do something. It’s about what you can do together to create the change that we need to see. Demonstrable leadership lets staff see “someone is doing something for us” and that can make people feel much better.

Tailoring support

Many BAME colleagues might not feel the well-being offers are necessarily for them unless they are culturally sensitive and flexible. Here are a few things to consider to ensure support is tailored and targeted:

  • Identifying those with a real interest in an issue who can support with input and advice
  • Empowering colleagues to help make improvements – working with those “a little bit on the fringe” who may be feeling marginalized can bring something that is different that will have an impact
  • Being culturally sensitive and aware of different cultural experiences – some BAME colleagues may have grown up in a country where race was a really important factor, where people were used to being openly categorized by a race
  • Taking time to consider the needs of all members of staff – everyone is individual and will want different things
  • Finding ways to make sure everyone hears the message about the kinds of support available

“It’s really important in our organization that we build a culture where we actually challenge some of our preconceptions that we truly value everyone; that we talk about assumptions and that we try and break down those sorts of assumptions and prejudice; because it exists everywhere. We all at one point or another will succumb to it, and we need to be able to be brave enough to speak about it openly and so that we can actually tackle it.”

Dr Navina Evans

Changes into the long term

The conversations regarding the support of BAME colleagues should not be limited. The issues raised under COVID-19 show that this needs to be addressed now and through into the long term: this is not a time-limited problem. A general improvement in practices would benefit the organisation, staff and patients beyond the ‘recovery phase’.

It was suggested that there will be a “resetting” of NHS after Covid where inequalities can be addressed as a core part of that research. BAME inequalities may be suitable for inclusion in the outcomes if the evidence and opportunities are readily available. Going “back to normal” is not ideal if the normal practice had deficiencies needing to be recognised.

Change can include:

  • Challenging leaders and politics
  • Increasing education about making small changes – “good things happen from the bottom up”
  • Holding on to small improvements is part of the journey so changes can spread
  • Increasing efforts at every level – a collective desire for change can produce a “wave”
  • Sustained attention – otherwise the opportunity can be missed

The relationship between leaders and BAME staff needs to be a working relationship. Policy and guidance are not likely to be enough on their own. Leaders need to be able to have a difficult conversation – listening to “what’s scary” and asking people to come up with what would work, what could help, and then making it happen.

You’d be surprised – it’s actually mostly quite simple stuff.

Navina Evans

Additional support

NHS England and NHS Improvement have supported an independent group of expert clinicians on the development of a risk assessment framework, in addition to existing guidance from NHS Employers. The framework encourages employers to take appropriate measures to mitigate the risk of Covid-19, including taking ethnicity and age into account alongside other risk factors. The framework is now available on the Faculty of Occupational Medicine and University of Leicester websites