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Equality, diversity and inclusion: From ideas and evidence into action

13 November 2020 | Professor Mike Roberts
Prof Mike Roberts on delivering equality, diversity and inclusion across the healthcare system.

The COVID-19 pandemic has brought few benefits to society but there are notable exceptions. One is the light it has shone on the inequalities in British society that have existed and – unacceptably – been tolerated for some time.

Mortality rates from COVID-19 were the first spark in that flame but behind the headline news that Black, Asian and Minority Ethnic communities are at greater risk is a complex and even now a poorly understood narrative. The Office for National Statistics data report mortality risk as two times higher in men of black ethnic origin compared to their white counterparts and 1.2 times higher for women. For men of Bangladeshi and Pakistani origin the risk is closer to 1.5 times higher and 1.6 times for those of Indian ethnicity.

These differential mortality rates have been particularly highlighted within NHS staff: 64% of healthcare workers who have died with COVID-19 are from Black, Asian and Minority Ethnic groups, despite just 20% of the NHS workforce being from these ethnic groups.

What started as a concern about the reasons behind this differential mortality and actions needed to mitigate risk have now quite rightly become broadened to a more generic view of health inequalities in our society and systemic racism within the NHS that requires urgent redress.

For UCLPartners, as an organisation driven by academic rigour in all we do, the research evidence in this area is a key source of knowledge. There is ample evidence that we as individuals and as a society have a serious problem. There is robust evidence of differential attainment throughout medicine where most of the research into the healthcare workforce is focussed, but also across nursing and other healthcare professions.

Differential attainment, which refers to the gap between levels of attainment of different groups of a profession attributable solely to a demographic characteristic, has been found throughout the medical career from admission to medical school, performance at medical school, success in postgraduate examinations, recruitment to specialty training, and to earnings.

Similarly, Black, Asian and Minority Ethnic nurses were found to earn less than their white colleagues and to be under-represented in senior management positions. The same conclusions were drawn from an analysis of Trust Board membership with under representation of ethnic minority groups.

Whilst the evidence for these findings is indisputable there is much less research evidence to help us understand what specific measures we might take that would address these differences in attainment outside of the broad concept of a ‘fairer society’. The temptation from an academic viewpoint might be to await further research evaluation for interventions, but whilst we will advocate for more research, frankly I don’t think we can wait any longer to address iniquities we have long been aware of!

A refreshing response to these challenges has come from the London Region NHSE/I Workforce Race Strategy document . As an organisation, UCLPartners stands unified to support our NHS and higher education partners in collating and sharing good practice and in using our expertise in implementation and behavioural change management to turn this document into a series of effective actions.

Before we can take up that role however, we must ensure that our own practices within UCLPartners are in order. Whilst it may be that not all NHS recommendations can be directly translated into our circumstances I personally make a commitment that UCLPartners will adopt all relevant principles from this London workforce document into our own organisation, adding to the AHSN Network equalities and diversity pledges that we signed in January 2020.

Working to meet these pledges has involved a process of discovery and learning for us at UCLPartners. Guided by a staff equality, diversity and inclusion (EDI) group, we have reviewed our recruitment and HR practices to align with the evidence on best practice in EDI, supported staff to share resources and reflections on events and movements such as Black History Month and #BlackLivesMatters and carried out activities as a staff team to reflect on privilege and our commitment to equality, diversity and inclusion. We are still learning.

Change will only come if we all engage actively in delivering that common vision of what constitutes equality, diversity, and inclusion. I believe that each and every one of us has something to give and much to learn. So what part will you play in this and what personal commitment will you give?