The Snowy White Peaks of the NHS

Lord Crisp

During Oral Questions in the House of Lords on February 10th I asked how many nurse directors there were in the English NHS from black and minority ethnic backgrounds. The depressing reply was that there were only 5 – from 170 NHS organisations. This is about 2.5%, yet 20% of NHS nurses are of black or minority ethnic origin.

In 2004 I published a 10 point Race Equality Plan which was designed to improve the way the NHS cared for its patients from black and minority ethnic backgrounds. Today, Roger Kline, a Middlesex University Business School Research Fellow, publishes his review of the progress made in the 10 years since this Plan was published. The review, The Snowy White Peaks of the NHS, is even more depressing and shows that the situation is no better now and, in some cases, worse. He has examined executive directors, non executive directors, and senior managers of NHS Trusts, alongside the leadership of the national NHS regulators and commissioners. All in all, there is a smaller proportion of people from black and minority ethnic backgrounds at the top of the NHS than in 2004.

Why does this matter?

Leaving aside the very important questions of equal opportunities and legalities, this is fundamentally about health and the health of the population. I created the Plan because regular surveys showed that both patients and NHS staff from black and minority communities were less satisfied with the NHS than people from the majority community. I believe this is still true today.

Research shows that the lack of representation affects staff morale amongst this population because it shows that there is little scope for advancement and suggests that their contribution is not valued. As Professor Michael West and his academic colleagues have shown, poor morale is in turn one of the main factors in the quality of care and is directly related to successful outcomes for all patients. Similarly, the lack of visible leaders from these communities affects patients’ experiences and confidence in the service – and in whether they see it as understanding and meeting their needs.

This is why it matters – and why it concerns us all. Improvements in the NHS depend on a motivated and committed workforce where everyone is able to contribute their best,

The Department of Health and NHS England need urgently to examine these findings closely and decide how they are going to make improvements. Even more importantly, it is a challenge to all the leaders of a newly decentralised NHS. Clearly, the impact is different in different parts of the country but the issues are the same. Are they not making use of all the talents in their workforce and their communities? Is lack of representation leading to poor morale and poor care? What are they doing about it?

I asked the Minister in February to ensure there was regular independent monitoring of this position. He didn’t respond. This reports shows that there needs to be independent and public scrutiny and challenge of the way people from black and minority ethnic backgrounds are represented in the leadership of the NHS.


5 comments for “The Snowy White Peaks of the NHS

  1. MilesJSD
    10/04/2014 at 1:17 pm

    Lord Crisp, before I can address your topics, as posted and as inferrable, I need to know
    (1) the
    (and possibly your or your school-of-thought’s)
    detailed definitioning, or understanding, of
    “Health-building & Wellbeing-Education”

    (2) as distinct from “Illness, The Medical & Nursing, and Primary Medical Care”
    {Note: the 1978 UN Primary Health Care Declaration specificly and generally pointed to our Need to widen the building of Health and of Wellbeing into other Sectors not just the Medical, Nursing and Pharmacological).

    (3) “What about Somatics ?”
    Beginning to conflict with the still-further-developing and dichotomising traditional medical, nursing, pharmacological and neural/brain-research foundations,
    is Somatics, Somatics Education; and even Primarily Somatic Tharapies both Subtle and Robust
    {the latter e.g. Rolfing:
    but which still stands outside of Mainstream Medical, Educational, and Lifestyle-wellbeing-building sectors this latter ‘sector’ being still one of the several “body-mind” = “somatics-first” know-how advances to be left in the Shadows to languish as a ‘cinderella’, way outside of the now newly traditional ‘core-social-mobility’ career-ladders, that jealously-privately march on 100% dominating many Establishments including ‘our’ British one}.
    Without my ‘rabbiting’ on further now, let me refer you to the final chapter in “The Body of Life” by Thomas Hanna;

    somatic abilities and education thereto are foundationally needed by all ages of people, and lifelong-needed to be initiated and refreshed.
    {jsdm’s paraphrasing}.

    If you will, kindly lighten our darkness, Lord Crisp.

  2. maude elwes
    11/04/2014 at 7:28 am

    Firstly, how about you being ludicrously ‘snowy’ and with little room for diversity in your department. I think you should be replaced by someone more favouring a diverse presentation before you give out this nonsense to all of us.

    Next, what we need to worry about here as a prioty in the UK about the state of our NHS is the likes of you and your set being in so tight with the US and the proposed full take over, by private concerns, of that which we all hold dear and pay highly for through our taxes. You are in with a crowd who want desperately to remove our health care system altogether because it doesn’t bode well for US barbaric non treatment of their own citizens. So, from my point of view, this is far more sinister and traitor like than the lack of ethnic minorities, or, as you are now claiming are ‘majorities’ in our working health care.

    And whilst I’m at it, since the influx of foreign health care workers, our NHS has deteriorated to such an extent it has become a ‘life in your hands’ experience to use it. And these individuals have not been used to uphold or support our ‘failing NHS’ quite the reverse, these foreign imports are used here as low paid shove ins to reduce the quality of care and to enable the likes of people like you to exploit its potential to make individual fortunes for the investors in pharmacy, medication, vaccination, etc. You are using the use of imported lack of compassionate care in the present service to support the takeover you want of uncontrollable privatisation. Again we are in desperate need of Direct Democracy. Put it to a vote and ask the people openly and in their face, do they want a privatised health care system akin to that of the USA.

    Diversity is a flag waving pretense for your crowd to push for more exploitation of our need for health care and not for the benefit of ethnic minorities. To use the US example of what is needed here is obscene as the healthcare for the population in that country is barbaric.

    And from a GP about what is going on.

    And what CNN had to say.

    What does privatisation offer? Nothing but disaster and you pay through the nose for it to make those in the business rich beyond reason. Listen to the cost and what you won’t get.

    And how we used to be before the NHS, which is what you plan to return us to.

    Not only was the NHS a life saver in the years by gone, but, the cars were so much prettier. A running board, a door that opens the right way, and a little arm to say you are turning the corner.

    Just saying how much better everything used to be when it was 1950’s.

  3. Honoris causa
    11/04/2014 at 3:43 pm

    There are things about abstracting statistics like that from an organization of 1.3m people(staff) which render it worthless.
    Ethnic minorities, and particularly Afro-Caribean people certainly do take up a large proportion of the more menial tasks.

    I was at Milton Abbey school yesterday where one boy of African/Caribean origin was being shown round the school with his mother; traders of some sort making a good living no doubt, but not in the state sector. They would not afford private education if they were, Bully for them!

  4. maude elwes
    16/04/2014 at 9:15 am

    First equality cannot pretend to stand when something is changed to become equality plus. The balance of equal opportunity changes immediately you legalise a criteria that removes its definition.

    How do you plan to do this? Sack an incumbent and replace them with the favoured entity? Direct ‘human resources’ within the NHS that all available positions in a specific sphere must be given only to a favoured group as ethnic minority? As this is to be based on ethnic make up or race that must exclude ‘snowy’, that creates a system where a percentage of the population, the ‘snowy,’ are discriminated against and therefore it becomes racist in its true form and imposed by government. We then end up with ‘institutional racism.’

    Now how did the NHS get into the position you tell us it has, where a large percentage of its workers are ethnic minorities? Was it as a result of a government directive requiring all available positions must be filled by immigrants before the indigenous are hired?

    Surely that would go against what is written in this document link.

    What you are suggesting is needed for more ethnic minorities who, according to my understanding on what you have written are now the majority of workers in the NHS, is more ‘positive action’ suggested by the ‘Race Equality Scheme.’ A rose by any other name, would suggest this is indeed ‘positive discrimination’ which in this country is illegal.

    If I have this all wrong can you please describe what action will be taken to make sure there are more ethnic minorities placed in the positions it is felt they don’t have or are less than they should be? And how the figures of the ‘right’ reflection would be seen in numbers in those jobs? Will it be comparative to the population make up or by another measure and if so, what measure?

    Which leads me to the fact that some inner London hospitals are run by a large percentage of ethnic minorities. Very few snowies can be found. Do you intend to make room for the missing ‘snowies’ to take over part of those hospital positions that they clearly are missing from? A very close friend of mine recently died in one London Hospital, he being a so called ‘ethnic minority’ who lived in an area where the population was greatly of the ethnic minority group, made this a comforting feel to him. All the friends and family were very happy and content with the mainly ethnic minority being those who managed his treatment and death with extreme professionalism. Was there something wrong with that scenario that government feel it should step in with the ‘Race Equality Scheme’ to insure the ‘snowies’ should be in there, rather than the staff that took care of him well, with kindness and with whom he identified and trusted? No matter their ability to do all of this, were they too many of the wrong race? If not in this area where the majority by far are of ethnic minorites, why is it felt that in areas that are predominately ‘snowy’ the change must be made to remove that ‘snowy’ status? Can anyone tell me what is being suggested on the ground here?

    Could it be because this dilemma is growing as a result of so called ‘white flight’? There are so few of the ‘snowies’ left you cannot find them any more in some parts of the country to take the positions on offer, high or low? As figures are so very hard to come by it is hard to know the un-meddled with truth as there are no documents giving the details or figures of just what is happening and so cannot be challenged at all. Not to mention the fear instilled in those who may wish to challenge it.

    Or, is all this really about bringing the levels of pay down in the higher positions of State, as I suspect it is?

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