D is for Diversity

Diversity brings a rich source of knowledge and experience into the workplace, but it is important to recognise that the process benefits from good management. Acknowledging differences and recognising their value can be challenging and lead to tensions. Organisations need to embrace a positive model to embed and embrace diversity.

Diversity runs through all our work and we believe it should be embraced holistically. We can help you introduce a range of interventions that will help your organisations develop a positive and effective approach to this complex issue.

If you’re interested to know how we can help you in managing equality and diversity in the workplace please visit our website

A Post About Faith Restored

I’ve written before about my journey, and how after 10 years I was a jaded NHS senior manager.  I tried and failed to be made redundant (how ironic in today’s climate). Instead, I resigned and went free-lance. I haven’t looked back since.

Over the last few years I have worked with a range of NHS organisations.  My blog has related my frustrations with NHS bureaucracy, and my dispair of disengaged HR staff who deliver poor service. 

About 8 months ago I heard of an opportunity at Kings College Hospital, London.  I was keen to get inside this high-profile organisation, who are known for being leaders in their field, including their approach to workforce intiatives and their “can-do” attitude.

However the timing was off, and so I couldn’t throw my hat in the ring.   A couple of months later I got another call and I was subsequently successful in being offered the opportunity to work a number of challenging and rewarding projects.

My first impressions are still vivid in my mind.   Whatever stone I unturned, there was a reasoned, well-thought through approach or response to how or why things were done in that particular way.  I wasn’t just looking at good practice – but excellent practice. 

I’m used to working with HR teams on their journey to improve their performance, moving them from mediocre to average.   But at Kings, I was faced with a different challenge.  I was out of my comfort zone, and I liked it. 

The most striking aspect of the Workforce Directorate is their attitude to team work.  It’s a stable team, with several members of staff having long service.  This hasn’t led to a culture of nepotism; there are friendships, but there aren’t any cliques.  All relationships are highly professional and everyone looks out for each other. 

Another key element is the fact that there isn’t a  blame culture.  Staff are willing to stand up and be accountable for human errors.  And in the same breath, they take a proactive, pragmatic appraoch to sorting them out.  No-one is afraid to make a mistake, which in turn leads to a more engaged and productive workforce.

My final observation was summed up by Tim Smart, the current Chief Executive at the staff’s Winter Diversity Event earlier this week.  He talked about how Kings is seen as an exemplar;  he is regularly being asked to speak at events to talk about the Trust’s approach to becoming “effortlessly inclusive”.  He highlighted that that Trust is still on its journey and there is still a lot of work to be done.  So it was important to recognise and be proud of all that the Trust has achieved to date with the acknowledgement that there is still much to be done.   And this gives the staff the drive, energy and passion to keep on improving performance.

I think over the last few years I have been searching for the Holy Grail.  And at Kings, I think I’ve found it.   

If I was 10 years younger, without kids and lived 10 minutes away, I would glady apply for a job at this Trust.  As it is, my personal circumstances are different.  But instead, all I can give is this post: a tribute to those within that Trust and for the fabulous experience I had working with them this last year.

Remind me, what’s the purpose of this?

Some weeks ago I published a post on the draft Equality Delivery System (EDS).   In brief, the EDS is a  a new framework that Trusts will use to measure how well they have embraced and embedded equality and diversity.  It was due to go out for consultation in November, but I have recently been informed that it’s postphoned until the New Year, although no reason has been given for this.  Pilot sites will start working towards their EDS in April 2011, with full-roll out in 2012.

The current framework of the EDS has been designed by individuals working either in PCTs or SHAs.  In my view the framework, as it stands in draft format, is not transferable to acute or mental health Trusts.    And this an issue, because we know that SHAs and PCTs aren’t going to exist in the very near future, so what is the point?     I understand that this is a question that is being discussed behind closed doors at some trade unions and professional bodies, who (reassuringly) share my views. For us, the consultation will be crucial, as it will be our only opportunity to significantly influence this initiative.

As I began to think through the implications of the EDS in conjuction with the White Paper, I recalled the following:  an ex-colleague of mine, who is now a leading figure in Equality & Diversity in the NHS, recently went on record saying a recent survey had established that c.34,000 GPs have a poor record in terms of their attitude towards diversity.  Unfortunately, he wasn’t around last week when I called to see where this figure came from.

It’s well documented that there is a genuine worry about the commissioning capability and capacity of the new GP consortia.  And there is quiet concern within the Equality & Diversity community about that the capability & capacity of GP consortias to run organisations who believe in equality and the concept of being “effortlessly inclusive”.  And to be clear, this isn’t just a workforce issue, but applies to patient services too.  (Ironically the White Paper is about reducing health inequalities). 

Am I taking it too far by thinking that the EDS has been designed to ensure that the GP consortia embrace and embed equality & diversity?  I think so, we’re not that visionary in the NHS.

Sometimes I feel that the NHS is like a tanker that has invested so much in trying to drive an initiative forward that it can’t change direction mid-course.    The EDS is such an iniative.   I heard a great quote recently when I was talking about the EDS with a leading Equality & Diversity specialist.  She described it as a “piece of furniture”: It sits in the corner of the room, but it looks out of place and nobody wants to use it.  That is exactly the opposite of what we should be striving for.

Another New & Crazy

I had an American CAPA intern working with me this summer. He was a lovely guy, who made the most of his internship.  He put in an intense 25 hours a week, had one class with an assignment to present each week, and managed to jet around Europe each weekend. I grew quite attached to Stephen and missed him when he left at the end of summer.

Stephen has emailed me a couple of times since, and this week he really hit the nail on his head when he wrote:

“Sounds like something new and crazy tends to happen everyday [in the NHS].”

Immediately I thought of the new Equality Delivery System (EDS):  a new framework that Trusts will use to measure how well they have embraced and embedded equality and diversity.  From 2012 the grades awarded to each Trust for complying with the System will be published by the CQC and counted in the overall Trust’s performance monitoring assessment.

The concept behind this initiative originated from a dynamic project in the North West.  Some months ago I had a conversation with the Project Lead, who explained that the project had evolved from an initial gap analysis and was primarily aimed at PCTs.  By the end of our conversation,  I felt that it would not be easy to transfer this concept to a Foundation or other acute /mental health Trusts and the HR Director I was working with at the time agreed.  So I admit, when it comes to the EDS,  I’m cynical from the start.

From an initial glance, I can’t see the point. All Trusts are required to have published Single Equality Schemes, action plans, and Equality Impact Assessments.  And there is also the live and real threat of a CEHR visit should they should lapse in any way. Why add this layer of bureaucracy?

Trusts are being approached to be early adopter sites. Great, except the framework hasn’t gone out to consultation and it is recognised that it may significantly change. So early adapters will have to put themselves forward without really knowing what they are volunteering for.   Why cause additional confusion?

And lastly, it looks like a lot of work. When all Trusts are either looking to make cuts because of financial pressures or as a result of the white paper, the last thing they need is additional administrative burden. Why now?

I’m not against effective monitoring of how inclusive a Trust is. It’s just that surely someone, somewhere should have asked the question:

‘Is there an easier, less time-consuming way to achieve this?’

I have plenty of suggestions is the DH is interested…..

The Equality Act: a lever for change

There’s a lot of discussion going around at the moment about how the Equality Act hasn’t quite gone far enough. I don’t disagree with those comments, but for me the Act brings the equalities agenda back to the top table and organisations are again reflecting on how well they manage inclusion.

From my perspective there are two key issues:

1) Equality, Diversity and Inclusion can be seen as an “add-on”.  

In many Trusts, (though more acute than PCTs) this is reflected in how they deliver their equalities agenda. 

Many Trusts are good at delivering interventions to patients and service users.  This includes reviewing their intrepretaton services, producing language cards, putting induction loops into every reception area.

But only the best Trusts are fully embracing public involvement in their approach to redesigning and developing services.  Patient and public views go beyond the equality strands, and it is important to listen to these views when working on service improvements.  

There are pockets of best practice out there, and sexual health is typically one of these, where there is already an embedded culture of inclusion. 

To take that first step towards inclusion is about recognising how powerful and important public involvement is, and then making some minor adjustments about how go about delivering service improvements.   The equality elements can then be drawn out and evidenced in an Equality Impact Assessment (EIA).

At the very least, there needs to be a recognition that there is a wealth of data out there that can be drawn upon to inform decisions from each of the different equality strands.  And there are a range of local community groups that will already be engaged with the Trust through their Public & Patient Involvement Forums.  Trusts needs to get better at using this information to inform their decisions.

2) the Equality Agenda can be compared to a piece of string. 

Each Trust makes their own decision of how long that piece of string will be:  some specialists believe that it should be the length of an entire ball of string.  In-house practioners who listen to managers saying “We don’t have the time for this” cut the string as small as they possibly can.

There is undeniably a fear around the equality agenda, and this could be because the agenda is huge.  This is evidenced through the lack of consistency across a “patch”. 

In the North West, the SHA has done a bespoke piece of work to bring consistency, which started with an in-depth analysis of how their local PCTs were implementing the Equalities Agenda.  A toolkit was produced which all 53 Trusts in the region are working to.  It’s a great piece of work, but it’s not transferable, and particularly not to acute Trusts.

In essence, none of us are sure what “best practice” really looks like, even with a simple process such as EIAs.  There’s little, if any, benchmarking undertaken.   We share information on a local, informal level, but ultimately it is the passion, credibility and priorities of the local Equality and Diversity Lead that will drive up standards within their own Trust.

So the Equality Act doesn’t address everything that we wanted it to.  But what it does do is give us an opporunity to talk to our Execs and Non-Execs about Equality & Diversity and what we need to do next on our journey to become fully inclusive.

The Impact of the Equality Act in the NHS

 We all know that the Equality Act 2010 received Royal Asset on 8 April 2010 (blah, blah) and that it replaced 9 major pieces of existing discrimination legislation (plus 100 other instruments) with one single Act and also introduced new law.  But what does it specially mean for NHS Trusts?

  1. We need to start using new language:  “protected characteristics” is the new phrase to represent the different diversity strands:   age, disability, gender reassignment, marital and civil partnership  status, pregnancy and maternity, race, colour, nationality, ethnic origin, religion or belief, sex and sexual orientation.                                  
  2. The Act harmonises the definitions associated with equality (ie: direct discrimination, indirect discrimination, harassment & victimisation).  Although it isn’t advisable, some HR departments include the different definitions in their policies.  Therefore, if you are one of these Trusts, you should review your policies – ideally taking out the section that provides the definitions, but otherwise updating them as appropriate.
  3. From next April, there’s a requirement to publish data relating to gender pay.  Whilst it may seem that Agenda for Change has already embedded equality into the system, it is worth taking a look at the average pay between men and women per pay banding.  You might get some interesting results!
  4. One of the most challenging areas will be to determine how best to implement the use of positive action in recruitment.  I think that this subject is so broad (and new) that a separate blog post should be dedicated to this.  But for now….spend time thinking about it and built it into your “Inclusion” action plan.
  5. In terms of Tribunals, there are two new points to consider.  The first is the new freedoms for Judges to make recommendations that will (apparently) benefit the wider workforce, not just the claimant, where the Tribunal makes a finding of unlawful discrimination.  Let’s hope that Judges are up to date on current thinking in relation to health-care management and clinical practice.  I envisage this area will be a minefield.
  6. And secondly,  The introduction of dual discrimination:  outlawing discrimination on the basis of two (and no more) protected characteristics (eg an asian woman can claim race and gender); This will make ET cases more interesting.

All Trusts need to keep a look out for the CEHR‘s new Employment Code of Practice and take action as appropriate (and again, another blog post will be coming once that’s published).

And on a serious note, the spirit of the new legislation is to ensure that organisations, such as the NHS, demonstrate they have a real commitment to equal opportunities not just by having in place a policy but also by demonstrating that the policy is actively implemented, monitored and reviewed, and that responsive action is taken;  How many Trusts can say they have “real commitment”? And that’s where the real challenge lies.